plan rules - riskinforiskinfo.com.au/.../files/2008/08/amp-death-tpd-plan-rules.pdf · amp flexible...

Flexible Lifetime® – ProtectionA safety net for living

Keep this document it is part of your contract with AMP Issued by AMP Life Limited ABN 84 079 300 379

® Registered trade mark of AMP Life Limited

Plan RulesDeAth, totAL AND PeRMANeNt DIsABLeMeNt AND tRAuMA

DeAth, totAL AND PeRMANeNt DIsABLeMeNt (suPeRANNuAtIoN)

2007

2007I

INNOVA-

Winner of the Asset Innovation Awards Trauma Insurance Product of the Year Flexible Lifetime – Protection Trauma cover Standard

This document

Please read this document with the Certificate of Insurance. We suggest you keep them together and in a safe place.

THIS DOCUMENT IS IN TWO PARTS: •abriefintroductionthatcoversthepurposeoftheplan, whom we pay, and who is

insured. It starts on the next page

• therulesofyourplan. A table of contents for the rules starts on page 3.

If there is something you don’t understand, please contact your financial planner or us.

UNDERSTANDING DEFINED Throughout this document:

TERMS IN THIS DOCUMENT • AMPmeanstheAMPGroup(theAMPGroupismadeupofseveralentities,whichinclude

AMP Superannuation Limited and AMP Life Limited)

• you,yourandyourself;inrelationtoDeath,TotalandPermanentDisablement

(Superannuation)plans means the insured person;andmeanstheplan owner in

relation to Death, Total and Permanent Disablement, Trauma plans

• AMPLife,we,us,andourmeansAMPLifeLimited

• TheFundmeanstheAMPPersonalSuperannuationFund

• insured person(s)meanstheperson(s)insuredundertheplan. In relation to Death, Total

and Permanent Disablement (Superannuation)plans the insured person is a member of

the AMP Personal Superannuation Fund

• plan owner in relation to Death, Total and Permanent Disablement (Superannuation)

plans means AMP Superannuation Limited, and means the owner of the plan for Death,

Total and Permanent Disablement, Trauma plans

• non-superannuation plan means Death, Total and Permanent Disablement, Trauma plan

under Flexible Lifetime – Protection. Your Certificate of Insurance will show if you have

this plan

• superannuationplanmeansDeath,TotalandPermanentDisablement(Superannuation)

planunderFlexibleLifetime–Protection(Superannuation).Your Certificate of Insurance

will show if you have this plan.

In addition:

• rule39describesTraumadefinitionsusedthroughoutthisdocument,and

• rule40containsa‘Glossaryofdefinitions’ofothertechnicalwordsusedinthisdocument.

Each time a defined word is used, it appears in type like this. Also, we list the defined words

used on each page in a box at the bottom left-hand corner of the page.

THESE WORDS AND

PHRASES ARE DEFINED:

• CERTIFICATEOF

INSURANCE

• INSUREdpERSON

• plAN

• plANOwNER

• TERMINAlIllNESS

THE DEFINITIONS ARE SET

OUTINRUlE40

AMP Flexible liFetiMe – Protection – PlAn rules – 1

introduction

PurPose For non-superannuation plans, this product provides you with a specified lump sum if you:

•haveselectedDeathcoverandtheinsured person dies or has less than 12 months to

live due to a terminal illness

•haveselected TotalandPermanentDisablement(TPD)cover,andtheinsured person

becomestotally and permanently disabled

•haveselectedTraumacoverandtheinsured person suffers one of the trauma

conditions we cover.

For superannuation plans, this product provides a specified lump sum if you:

•dieorhavelessthan12monthstoliveduetoaterminal illness

•haveselectedTotalandPermanentDisablement (TPD)cover,andbecome totally and

permanently disabled.

You may have additional options on your plan.

the cover the insured person has is shown on the Certificate of Insurance. that

information is updated each year in the Annual statement.

WHo We PAY For non-superannuation plans, we pay you.

For superannuation plans,wepayAMPSuperannuationLtdwhowillpaythebenefitin

accordancewiththeTrustDeedoftheFund.

INSUREDPERSON For non- superannuation plans more than one insured personcanbecoveredunderthe

plan.Forexample,youcanaskustoinsureyourspouse,child,orbusinesspartner,aswell

as yourself. You can do that at any time – even after we have issued the plan.

Youmayinsureachild(forChildren’sTraumacover)whenanadultisincludedasan

insured person under the plan.

Youcanalsobeaninsured person or you can own the planbutnotbeaninsured

person.

THESE WORDS AND


• CERTIFICATEOF

INSURANCE

• INSUREDPERSON

• PlAN

• PlANOWNER

• TERMINAlIllNESS

• TOTAllYAND

PERMANENTlYDISABlED

• TRAUMACONDITIONS

THE DEFINITIONS ARE

SETOUTINRUlE40

2 – AMP Flexible liFetiMe – Protection – PlAn rules

cHAnGinG Your PlAn once the plan has started, you can apply to change it. For some changes, all you need to

doistellusbycallingusorinwriting.Forothers,youmayhavetosupplymoreinformation

for us to consider. You should contact your financial planner or us to discuss this.

tHe rules Therulesdescribingyourplan are set out on the following pages. When the plan starts,

these rules and the Certificate of Insurance we sent you with these Plan rules form the

contract and plan with us.

THESE WORDS AND


• CERTIFICATEOF

INSURANCE

• PlAN

THE DEFINITIONS ARE

SETOUTINRUlE40


Tableofcontents

What has to happen for us to pay

reasons why we pay a lump sum 1 7

Waiver of premium option 1.2 8

stand alone cover or linked cover 2 8

trauma cover – adults 3 9

Table1–TraumacoverPremier – 10

Table1.1–PremierPartialsPlusoption – 11

Table2–TraumacoverStandard – 11

cover for some trauma conditions is delayed 3.1 11

trauma conditions suffered in three month period 3.2 12

TotalandPermanentDisablement(TPD)cover 4 12

Terminalillnessbenefit–adults 5 12

Deathcover 6 13

FuneralBenefit 6.1 13

FinancialPlanningBenefit 6.2 13

This rule has been removed 6.3

BusinessSafeguardoption 6.4 14

Children’sTraumacover 7 15

Thetraumaconditionswecover 7.1 15

Table3–Children’sTraumacover – 15

Coverforsomeconditionsisdelayed 7.1.1 16

Traumaconditionssufferedinthreemonthperiod 7.1.2 16

Children’sTraumacoverchangestoDeathcover 7.1.3 16

DeathcoverprovidedunderChildren’sTraumacover 7.2 16

How much we pay

What we pay 8 17

When we pay 9 17

Howmuchwepay 10 17

Terminalillnesscover–$2,000,000limit 10.1 17

Changestotheamountofcover 10.2 17

Taxesorcharges 10.3 17

cover amounts may change after we pay 11 18

Children’sTraumacover 11.1 19

TraumaPremierwithBuybackoption 11.2 19

example – 19

TraumaPremierReinstatementoption 11.3 20

rule no. Page no.


Whenwewon’tpay

on purpose 12 22

Death–orterminalillness–byownhand 13 22

Children’sTraumacover 14 22

Increasingbenefitsautomatically

Indexationfeature 15 23

Increasesstopatacertainage 15.1 23

You can decline increases – 23

When the plan and cover start and end

Whentheplanandcoverstart 16 24

Whentheplanandcoverend 17 24

Whenwecanendtheplan 17.1 25

Refundofpremiums 18 25

Restartingtheplan – 25

Guaranteed continuation of cover

Weguaranteetocontinueyourplan 19 26

Keeping you informed

Wesendyouanannualstatement 20 26

changing your plan

You can change your plan 21 27

Automatic plan enhancements 21.1 27

Guaranteedfutureinsurability 21.2 28

rule no. Page no.


Premium – what you have to pay

Howmuchandwhen 22 30

Governmenttaxes,duties,andcharges 22.1 30

Premium guarantee 23 31

Premium rates and discounts not guaranteed 23.1 31

Keeping the premium the same – 31

Ifwereduceourpremiumrates 24 32

Planfee 25 32

Premiumfrequencyfee 26 32

Discounts 27 32

Whenyoudon’thavetopaypremiums

if we pay you 28 33

Waiver of premium 29 33

Waiverofpremiumoption–individuallife 29.1 34

Waiverofpremiumoption–nominatedlife 29.2 34

How to make a claim

Whattodo 30 35

Healthandotherinformation 30.1 35

Ageandidentity 30.2 35

Timelimits 31 36

Lateclaimsandresponses 32 36

rule no. Page no.


Miscellaneous

ownership and transfers 33 37

Governinglaw 34 37

Australian$ 35 37

Ourliabilityislimited 36 37

no share of profits 37 37

This rule has been removed 38 –

trauma definitions and descriptions

Descriptionsoftraumaconditions 39 38

Glossary of definitions

Glossaryofdefinitions 40 64

enquiries and complaints

Contactus – 69

TimelimitsonmakingcomplaintstotheSCT – 70

rule no. Page no.


non-suPerAnnuAtion PlAn

Therearethreetypesofcoveravailableinnon-superannuationplans.

the three types of cover are:

1. trauma cover – if the insured person suffers a trauma condition, and survives

aspecifiednumberofdays,wepayalumpsum–seerule3.Thereare2levelsof

cover, trauma cover standard and trauma cover Premier. Premier covers more trauma

conditions than standard.

if a child is covered as an insured personunderChildren’sTraumacover,wepaya

lump sum if they suffer a trauma condition or die – see rule 7.

2.TotalandPermanentDisablement(TPD)cover–iftheinsured personbecomestotally

and permanently disabled,wepayalumpsum–seerule4.

3.Deathcover–

•Terminalillnessbenefit–iftheinsured person has less than 12 months to live, we pay

theamountwewouldpayiftheyhaddied(upto$2,000,000).Upondeath,wepayany

remainingDeathcover,ifapplicable–seerules5and10.1.

•Death–iftheinsured person dies, we pay a lump sum.

suPerAnnuAtion PlAn

TherearetwotypesofcoveravailableinSuperannuationplans.

the two types of cover are:

1.TotalandPermanentDisablement(TPD)cover–ifyoubecometotally and

permanently disabled,wepayalumpsum–seerule4.Note,TPDcovercanonlybe

selectedifDeathcoverisalsoselected.

2.Deathcover–

• Terminalillnessbenefit–ifyouhavelessthan12monthstolive,wepaytheamount

wewouldpayifyouhaddied(upto$2,000,000).Upondeath,wepayanyremaining

Deathcover,ifapplicable–seerules5and10.1.

•Death–ifyoudie,wepayalumpsum.

the Certificate of Insurance shows the type, or types, of cover, which apply to the

insured person(s).

What has to happen for us to pay

THESE WORDS AND


• CERTIFICATEOF

INSURANCE

• INSUREDPERSON

• PlAN

• TOTAllYAND

PERMANENTlYDISABlED

• TRAUMACONDITION


OUTINRUlE40

1.

reAsons WHY We PAY A luMP suM


1.1 Thisrulehasbeenremoved

1.2

WAiVer oF PreMiuM oPtion under this option, we will waive premiums that fall due under your plan if the insured

person is totally disabledforaperiodofmorethan6months. We may waive some

or all of the premiums falling due under this option, depending on whether you have

selected “nominated life “ or “individual life “. see rule 29.

2.

STANDALONECOVERORLINKEDCOVER if an insured person is covered for more than one type of cover, all their cover is either

Stand alone or linked:

• Stand alone means that each type of cover is completely independent of all other types

of cover that apply to an insured person under this plan. if we pay under one type of

cover,itdoesn’taffecttheamountofanyothercoverforthat insured person. the only

timethisdoesn’tapplyisifwepayunderTerminalIllnessbenefit,whenwereducethe

amountoftheDeathcoverthatappliestothe insured personbytheamountwepay.

•linked means that each type of cover for an insured person is dependent on each

other type of cover. if we pay under one type of cover, the amount of each remaining

type of cover that applies to that insured personisreducedbytheamountwepay.See

rule 11.

note, if an insured personiscoveredforonlyonetypeofcover,it’streatedas Stand alone.

exAMPle

IndiraownsaFlexibleLifetime–Protectionplan under which she is an insured person.

she has:

•Traumacoverof$200,000,and

•Deathcoverof$300,000.

if she chooses Stand alone coverandwepayherbecauseshesuffersa trauma

condition,herTraumacoverwouldendbutherDeathcoverwouldcontinueunchanged.

instead if she chooses linkedcoverandwepayherbecauseshesuffersatrauma

condition,herTraumacoverwouldendandherDeathcoverwouldbereducedby

$200,000.Thatis,herDeathcoverwouldbereducedto$100,000.

THESE WORDS AND


• CERTIFICATEOF

INSURANCE

• INSUREDPERSON

• lINKED

• MONTH

• PlAN

• PREMIUM

• STANDAlONE

• TOTAllYDISABlED

• TRAUMACONDITION


OUTINRUlE40.

Your Certificate of Insurance shows whether the cover that applies to an insured

person is Stand alone or linked.


3.

TRAUMACOVER–ADULTS

AVAILABILITY Notavailabletosuperannuationplans.

We pay if an insured person suffers a trauma condition,andsurvivesfor14

days. note, the trauma condition for coma has a different survival period. see the

description for coma in rule 39.

Thedescriptionsinrules30,31and39setouttheotherrequirementsthatmustbemet

beforewepay.

Thenumberoftrauma conditions an insured person is covered for depends on if

you have selected:

•TraumacoverStandard,or

•TraumacoverPremier,or

•TraumacoverPremierwithPartialsPlusoption.

Tables1,1.1and2showwhichtrauma conditions are covered under each of the

covertypesabove.

For each insured person the Certificate of Insurance shows whether standard,

Premier, or Premier with Partials Plus option applies and when the cover starts and ends.

note, cover is delayed for three months for some trauma conditions.SeeTables1,

1.1 and 2.

THESE WORDS AND


• CERTIFICATEOF

INSURANCE

• INSUREDPERSON

• MONTHS

• PlAN



OUTINRUlE40.

Your Certificate of Insurance shows whether trauma cover - adults applies to an

insured person.TheruleonChildren’sTraumacoverissetoutinrule7.


Trauma cover Premier covers the following trauma conditions for adults*

Coverfortheconditionsinthiscolumn

starts immediately

Coverfortheconditionsinthiscolumn

is delayed for three months. See rules

3.1 and 3.2

Alzheimer’sdiseaseandotherdementias Aortic surgery

Aplastic anaemia Benigntumourofthebrainorspinalcord

blindness cancer

cardiomyopathy coronary artery angioplasty– triple vessel

coma coronary artery surgery

encephalitis Heart attack– myocardial infarction

HIV/AIDS–medicallyacquired Heart attack– out of hospital cardiac arrest

HIV/AIDS–occupationallyacquired Heart valve surgery

intensive care open heart surgery

Kidney failure Pneumonectomy

liver failure severe rheumatoid arthritis

loss of hearing stroke

loss of independent living

loss of speech Partial benefit only:

Lossofuseoflimbsand/orsight Cancer(Partial)

lung failure Coronaryarteryangioplasty(Partial)

Major head trauma Parkinson’sdisease(Partial)

Major organ transplant

Motor neurone disease

Multiple sclerosis

Muscular dystrophy

Myelodysplasia

Myelofibrosis

Paralysis that is one of:

•diplegia

•hemiplegia

•paraplegia

•quadriplegia

•tetraplegia

Parkinson’sdisease

Peripheralbloodstemcellorbonemarrow transplant

Peripheral neuropathy

Primary pulmonary hypertension

Severeburns

systemic lupus erythematosus

systemic sclerosis

* From the plan anniversary following the insured person’s69thbirthday,theonly

trauma conditions coveredareLossofindependentlivingandLossofuseoflimbs

and/or sight.

THESE WORDS AND


• INSUREDPERSON

• PlAN



OUTINRUlE40.

Table1


THESE WORDS AND


• CERTIFICATEOF

INSURANCE

• CPI

• INSUREDPERSON

• MONTHS

• PlAN

• PlANANNIVERSARY

• TRAUMACONDITION


OUTINRUlE40.

Table1.1

The Partials Plus option covers the following trauma conditions for adults

Coverfortheconditionsinthis

column starts immediately

Coverfortheconditionsinthiscolumnis

delayed for three months – see rules 3.1 and 3.2

Partialblindness Melanoma

Prostate cancer

Severeinflammatoryboweldisease

severe osteoporosis

Table2

Trauma cover Standard covers the following trauma conditions for adults*

Coverfortheconditionsinthis

column starts immediately

Coverfortheconditionsinthiscolumnis

delayed for three months – see rules 3.1 and 3.2

Kidney failure Aortic surgery

Major organ transplant cancer

Paralysis that is one of: coronary artery surgery

– diplegia Heart attack – myocardial infarction

– hemiplegia Heart attack – out of hospital cardiac arrest

– paraplegia Heart valve surgery

– quadriplegia stroke

– tetraplegia

Peripheralbloodstemcellorbone

marrow transplant

* From the plan anniversary following the insured person’s64thbirthday,theonlytrauma

conditions coveredareLossofindependentlivingandLossofuseoflimbsand/orsight.

Forustopaybecauseaninsured person suffers one of the trauma conditions listed in

therighthandcolumnofTable1,Table1.1orTable2,theinsured person must suffer

the trauma condition more than three months after the trauma cover for the insured

person starts or restarts. that date is shown on the Certificate of Insurance or in the

document in which we told you that we have restarted the trauma cover or plan.

Also, if we have increased the amount of the trauma cover for that insured person

becauseyouaskedusto,andwithinthreemonths after the increase that insured person

suffers one of the trauma conditionsintherighthandcolumnofTable1,Table1.1or

Table2,wepaytheamountthatappliedbeforetheincrease.Thatthreemonth period

starts on the date from which the increase applies.

these restrictions do not apply to regular CPI increases.

if your plan replaces a previous planissuedbyusoranotherinsurer,thethreemonth

delayexplainedpreviouslywon’tapplyifyouwereeligibletoclaimforthesamecondition

under the previous plan provided:

•thepreviousplan was in force at the time we issued your plan, and

•thepreviousplan was in place for at least three months.

We will require satisfactory evidence of these points at the time of any claim for this

to apply.

3.1

coVer For soMe trAuMA

CONDITIONSISDELAYED


THESE WORDS AND


• CERTIFICATEOF

INSURANCE

• DOCTOR

• HOMEDUTIES

• MONTH

• OWNOCCUPATION

• REGUlARREMUNERATIVE

WORK

• TERMINAlIllNESS

• TOTAllY&PERMANENTlY

DISABlED

• TRAUMACONDITION


OUTINRUlE40

if an insured person suffers a trauma condition in the right hand column of the trauma

covertableswithinthreemonths after the trauma cover for that insured person starts,

orrestarts,we’llneverpayforthatcondition,eveniftheinsured person suffers it again

later.

We pay if:

•anillnessorinjurywhichcausesaninsured persontobecometotally and permanently

disabled happens while that insured personiscoveredbyTPDcover,and

•theysurviveforsixmonthsafterthedateonwhichtheystopperforming(orwould

havestoppedperforming)homeduties,regularremunerativework, or their own

occupationbecauseoftheirillnessorinjury.

However, if an insured person meetsthedefinitionofTPDbecauseofeitherLossofuseof

limbsand/orsightorLossofindependentlivingorLossofcognitivefunctioningunderthe

definition of totally and permanently disabled,theyonlyneedtosurvivefor14days.

For superannuation plans,wepayAMPSuperannuationLtdwhowillpaythebenefitto

youinaccordancewiththeTrustDeedoftheFund.

5.

TERMINALILLNESSBENEFIT–ADULTS

We pay if an insured person is diagnosed as having less than 12 months to live. For us

to pay, the insured person’s doctormusttellusinwritingthattheybelievetheinsured

person has less than 12 months to live. the doctor’sbeliefmustbebasedonclinical

findings and reports. We will only pay if we agree with the doctor. We may also require

you to give us information from medical advisers we choose.

3.2

TRAUMACONDITIONSSUFFEREDIN

THREEMONTHPERIOD

4.

TOTALANDPERMANENTDISABLEMENT

(TPD)COVER

Your Certificate of InsuranceshowswhetherTPDcoverappliestoaninsuredperson

ThiscoverisbuiltintoDeathcover.IftheDeathcoverappliestoan insured person,

that person is automatically covered for terminal illness. Your Certificate of

InsuranceshowswhetherDeathcoverappliestoaninsured person.


THESE WORDS AND


• CERTIFICATEOF

INSURANCE

• INSUREDPERSON

• MONTH

• PlAN

• PlANOWNER


OUTINRUlE40.

6.

DEATHCOVER

We pay if the insured person dies.

6.1

FunerAl beneFit

AVAILABILITY Notapplicabletosuperannuationplans.

WHATHASTOHAPPENFORUSTOPAY Wewilladvanceyou,onyourrequest,partoftheDeathcoveramountontheproduction

of the insured person’s death certificate, while we are assessing the death claim.

Theadvancewillbemadetoeither:

•asurvivingplan owner, or

•ifthe plan owner is deceased, and on completion of an indemnity and discharge in a

formacceptabletous,toanypersonconsideredbyustobedependentontheinsured

person at the time of their death.

HOWMUCHWEPAY Wewilladvanceupto$10,000.TheDeathcoveramountontheplanwillbereduced

bytheamountoftheadvance.TheremainderoftheDeathcoverwillbepayableupon

acceptance of a death claim.

6.2

FinAnciAl PlAnninG beneFit

AVAILABILITY Notapplicabletosuperannuation plans.

WHATHASTOHAPPENFORUSTOPAY Wewillreimburseyouforthecostoffinancialplanningadviceafterabenefitpaymenton

this plan.

Thefinancialadvicemustcomefromasuitablyqualifiedpersonacceptabletous.

HOWMUCHWEPAY Wewillreimburseyouupto$1500,additionaltotheamountofthebenefitpaid.

WHENWEPAY Wewillreimburseyouafterthebenefithasbeenpaidandyouproduceevidenceofthis

expenseinaformacceptabletous.

HOWOFTENWEPAY Thisbenefitispayableonlyonceforeachinsured person on this planandmustbe

claimed within twelve monthsofthebenefitbeingpaid.

Your Certificate of InsuranceshowswhetherDeathcoverappliestoaninsured person.


THESE WORDS AND


• INSUREDPERSON

• PlAN

• TERMINAlIllNESS


OUTINRUlE40.

6.3 Thisrulehasbeenremoved

6.4

BUSINESSSAFEGUARDOPTION

AVAILABILITY Notapplicabletosuperannuationplans.

WHENYOUCANINCREASEYOUR YoumayapplytoincreasethelevelofDeathorTPDcover,orbothDeathandTPDcovers

DEATHORTPDCOVER withoutfurthermedicalevidence.

HoW MucH You cAn increAse You can apply to increase the cover under this option:

COVERBY •ifthisplanformspartofawrittenbuy/sell,sharepurchaseorbusinesscontinuation

agreement:bytheactualincreaseinthevalueofyourinterestinthebusinesssincethe

latter of last time the option was exercised and the commencement of the option, or

•iftheinsured personisakeypersontothebusiness,theactualincreaseinthevalue

of the insured persontothebusinesssincethelatterofthelasttimetheoptionwas

exercised and the commencement of the option.

WHENDOESTHEOPTIONEND? Theoptionwillceasewhenanyofthefollowingoccurs:

•youdon’texercisetheoptionforfiveyears.

•after10yearsfromthecommencementoftheoption

•theinsured personturns65

•theDeathorTPDcoverisfivetimestheoriginalamount

•theDeathcoverreaches$15,000,000ortheTPDcoverreaches$2,500,000

•theinsured personhasreceived,oriseligibletoreceive,abenefitunderthisoranother

life insurance plan.

ELIGIBILITYTOINCREASE Youcan’ttakeupthisoptionifatthetimeofyourrequestthe insured person has made

oriseligibletomakeaterminal illness,traumaorTPDclaimunderanyplan with us.

CONDITIONSOFINCREASE Wewillrequirefinancialevidenceoftheincreaseinthevalueofthebusinessfroman

independentqualifiedaccountant,businessvaluer,orotherappropriatepersonallofwhom

mustbeapprovedbyus.


7.

CHILDREN’STRAUMACOVER Notavailabletosuperannuationplans.

7.1

THETRAUMACONDITIONSWECOVER

We will pay if an insured person suffers a trauma condition,andsurvivesfor14days.

Thedescriptionsinrules30,31and39setouttheotherrequirementsthatmustbemet

beforewepay.

For some trauma conditions, cover is delayed for three months. For the others, cover

only applies to an insured personwhohasturned10.TheCertificate of Insurance

showswhenChildren’sTraumacoverstarts.Thecoverfortrauma conditions under

Children’sTraumacoverendsaftertheinsured personturns16andautomatically

convertstoDeathcover.SeeRule7.1.3.

Table3

Children’sTraumacovercoversthefollowingtraumaconditionsforchildren

Coverforthetraumaconditionsinthis

column starts immediately*

Coverforthetraumaconditionsinthis

column is delayed for three months.

See rules 7.1.1 and 7.1.2

Major head trauma Aplastic anaemia

Major organ transplant bacterial meningitis

Paralysis that is one of: cancer

•diplegia leukaemia

•hemiplegia Subacutesclerosingpanencephalitis

•paraplegia Viral encephalitis

•quadriplegia

•tetraplegia

Peripheralbloodstemcellorbonemarrow

transplant

Severeburns

*Ifthechildisunder10,coverisdelayeduntiltheyturn10.

THESE WORDS AND


• CERTIFICATEOF

INSURANCE

• INSUREDPERSON

• MONTH

• PlAN

• TRAUMACONDITION


OUTINRUlE40.

Your Certificate of Insurance shows whether it applies to an insured person.

this rule applies to insured personscoveredunderChildren’sTraumacover.SeeRule

3 for trauma conditions covered under trauma cover standard, trauma cover Premier

and trauma cover Premier with Partials Plus option.


7.1.1

coVer For soMe trAuMA For us to pay when an insured person suffers a trauma condition listed in the right hand

CONDITIONSISDELAYED columnofTable3,theinsured person must suffer the trauma condition more than

three monthsaftertheChildren’sTraumaCoverforthatinsured person starts or restarts.

that date is shown in the Certificate of Insurance or in the document in which we told

youthatwehaverestartedtheChildren’sTraumacoverortheplan.

Also,ifwehaveincreasedtheamountoftheChildren’sTraumacoverbecauseyouaskedus

to, and within three months after the increase the insured person suffers one of the trauma

conditionsintherighthandcolumnofTable3wepaytheamountthatappliedbeforethe

increase. the three month period starts on the date from which the increase applies.

these restrictions do not apply to regular CPI increases.

if your plan replaces a previous planissuedbyusoranotherinsurer,the3month delay

explainedpreviouslywon’tapplyifyouwereeligibletoclaimforthesameconditionunder

the previous plan provided:

•thepreviousplan was in force at the time we issued your plan, and

•thepreviousplan was in place for at least three months.

We will require satisfactory evidence of these points at the time of any claim for this to apply.

7.1.2

TRAUMACONDITIONSSUFFEREDIN if an insured person suffers:

THREEMONTHPERIOD •atrauma conditionlistedintherighthandcolumnofTable3onpage15withinthree

months after the cover for that insured person starts, or restarts,

•atrauma conditionlistedinthelefthandcolumnofTable3onpage15beforetheyturn

10,wewon’teverpayforthatcondition,eveniftheinsured person suffers it again later.

7.1.3

CHILDREN’STRAUMACOVER At the plan anniversaryonorbeforetheinsuredchild’s17thbirthday,theChildren’s

CHANGESTODEATHCOVER TraumacoveranditsbuiltinDeathcoverends.However,atthatdatetheamountofthe

Children’sTraumacoverautomaticallychangestoDeathcover(whichincludesbuilt-in

terminalillnessbenefit,GuaranteedfutureinsurabilityandFuneralbenefit).

7.2

DEATHCOVERPROVIDEDUNDER

CHILDREN’STRAUMACOVER

WepayifaninsuredchilddieswhilecoveredbyChildren’sTraumacover.Wewillpay

$10,000.

. Note,thisDeathcoverendsifwepaybecausetheinsured person suffers one of the

trauma conditionscoveredunderChildren’sTraumacover.

THESE WORDS AND PHRASES ARE DEFINED:

•CERTIFICATEOFINSURANCE

• CPI

• INSUREDPERSON

•MONTH

• PlAN

•PlANANNIVERSARY

•TRAUMACONDITION

THEDEFINITIONSARESETOUTINRUlE40

Deathcover(excludingtheTerminalIllnessbenefit,Guaranteedfutureinsurabilityand

Funeralbenefit)isbuiltintoChildren’sTraumacover.


THESE WORDS AND PHRASES ARE DEFINED:

• CPI

• HOMEDUTIES

• INSUREDPERSON

• MONTH

• OWNOCCUPATION

• PlAN

• REGUlARREMUNERATIVEWORK

• TERMINAlIllNESS

• TERMINAllYIll


THEDEFINITIONSARESETOUTINRUlE40.

8.

WHAt We PAY We pay a lump sum.

9.

WHen We PAY We will pay as soon as we have processed a claim which satisfies the rules of the plan.

10.

HoW MucH We PAY trauma cover – we pay the amount of the cover that applies on the date that the

requirements of the trauma condition was met.

TPDcover–wepaytheamountofcoverthatappliesonthedatesixmonths after the

insured personstoppedperforming(orwouldhavestoppedperforming)home duties,

regularremunerativework or their own occupation.

TerminalIllnessbenefit–wepaytheamountofDeathcoverthatappliesonthedatewe

agree with the terminal illnessdiagnosis.Seerule10.1.

Deathcover–wepaytheamountofcoverthatappliesonthedatelistedinthedeath

certificate(oronthedateofdeath).

Note,ifwehavealreadypaidyoubecauseofsomethingthathappenedtothatinsured

person,anyremainingcovermayhavebeenreduced.Seerule11.

10.1

terMinAl illness Ifwepaybecausetheinsured person is terminally ill, we will advance you up to

COVER–$2,000,000LIMIT $2,000,000ofanyDeathcoveramount.the most we will pay altogether under all AMP

plansbecauseaninsured person is terminally illis$2,000,000.Ifthe$2,000,000limit

applies,wereducetheDeathcoverthatappliestothatinsured personbytheamountwe

pay, and later when they die, we pay any remaining death cover.

10.2

cHAnGes to tHe AMount oF coVer After the plan starts, the amount of each cover for an insured person may change in any

of the following ways:

•itcanincreaseeachyearbyanyincreaseintheCPI. each year, we will show the new

amount in the Annual statement, or

•itcanchangewhenyouaskustochangeit.Ifithaschangedinthisway,wewillshow

the new amount in the document we send you to record the change, or

•itwillreduce–perhapstozero–foraninsured personifwepaybecausesomething

happens to that insured person. see rule 11.

10.3

tAxes or cHArGes We deduct any taxes or government charges from the amount we pay:

•whichthelawrequiresustodeduct,or

•whichhavetobepaidandwhichwedecidetodeduct.

How much we pay


THESE WORDS AND PHRASES

ARE DEFINED:

• CERTIFICATEOFINSURANCE

• INSUREDPERSON

• lINKED

• STANDAlONE

• TRAUMACONDITION

THE DEFINITIONS ARE SET OUT

INRUlE40.

if cover is stand alone

Ifwepayabenefitforaninsured person and the cover that applies to them is Stand

alone:

•thecoverforwhichwepaidends,and

•ifwepaytheTerminalillnessbenefit,thedeathcoverforthat insured person also ends.

However,ifthe$2,000,000limitinrule10.1applies,thedeathcoverisonlyreducedby

the amount we pay; and

•theamountofanyothercoverthatcontinuesforthat insured person stays the

same – that is, these amounts are not reduced. note, if the insured person dies, all

cover for that insured person ends.

the Certificate of Insurance shows if cover is Stand alone.

if cover is linked

Ifwepayabenefitforan insured person and the cover that applies to them is linked:

•thecoverforwhichwepaidends,and

•wereducesome,orall,ofanyothercoverforthatinsured personbytheamountwe

paid, and

•some,orall,ofanyothercoverforthat insured person will end.

We explain the way covers are reduced in the example provided under rule 2 on page 8.

the Certificate of Insurance shows if cover is linked.

11.

coVer AMounts MAY cHAnGe

AFter We PAY


THESE WORDS AND


• BUYBACK

• CERTIFICATEOF

INSURANCE

• INSUREDPERSON

• lINKED

• PlANANNIVERSARY

• PREMIUM

• PREMIUMRATES

• TRAUMACONDITION


OUTINRUlE40.

11.1

CHILDREN’STRAUMACOVER Ifwepaybecauseaninsured person suffers a trauma conditionunderChildren’s

trauma cover or dies, all cover for that insured person ends.

11.2

trAuMA PreMier WitH Your Certificate of Insurance shows if theBuybackoptionhasbeenselected.

buY bAcK oPtion theBuybackoptionisonlyavailableifyouchooseDeathcoverlinked with your trauma

cover Premier. if you select theBuybackoption,youwillbeabletorestoretheDeath

cover on the planbytheamountitwasreduceduponafullTraumacoverclaim.The

optiontorestoretheDeathcoverbecomesavailableoneyearafterwepaythefullTrauma

coverclaim,andisexercisablefor30days.

WewillbasethepremiumforthenewcoveronournormalDeathcoverpremium rates

and the insured person’s age at the time, taking into account the cover amount, and

any special conditions or premium loadings applying to your original cover. the Buyback

option will cease on the plan anniversary following the insured person’s64thbirthday.

TheindexationfeatureandGuaranteedfutureinsurabilityarenotavailableontherestored

Deathcover.

exAMPle

JennyownsaFlexibleLifetime–Protectionplan under which she is an insured person.

she has:

Deathcoverof$300,000linkedwithTraumacoverPremierof$200,000.Shehas

also selected the Buyback option. if she suffers a trauma condition, we will pay her

$200,000,andherDeathcoveramountwillreduceto$100,000.Oneyearafterwepay

theclaim,JennycanaskustorestoreherDeathcoveramountbackto$300,000.


11.3

trAuMA PreMier reinstAteMent oPtion Your Certificate of InsuranceshowsiftheTraumaReinstatementoptionhasbeen

selected.

TheTraumaReinstatementoptioncanonlybeselectedwhenyouchooseTraumacover

Premier.

ThisoptionallowsyoutochoosetorestorethefullTraumabenefitamountwehavepaid

after a full trauma claim, without having to provide additional evidence of health, details of

the insured person’s occupation or pastimes. the trauma reinstatement option does not

applytoanypartialtraumabenefitswepay.

ThisoptionbecomesavailableoneyearafterwepaythefullTraumacoverclaim,andis

exercisablefor30days,bycompletingtherelevantapplicationform.Wewillbasethe

premium for the Reinstated Trauma coveronourTraumacoverratesapplicableatthe

time and the insured person’s age at the time, taking into account the sum insured and

any special conditions or premium loadings applying to the original trauma cover.

the option to reinstate the cover will cease on the earlier of the following:

•thedateshownintheCertificate of Insurance, and

•13monthsafterthedateoftheoriginalfullTraumaclaim.

Youcan’texercisetheTraumareinstatementoptionifwehavepaidatraumaclaimforany

benefitthatisapartialbenefit(whetherunderPremiercoverorthePremierPartialsPlus

option).

if the Premier with Buyback option applies to your plan(seeRule11.2),youmustrestore

theDeathcoveronyourplan at the same time you restore your trauma cover otherwise

youlosetheoptionrestoretoyourDeathcoveratafuturedate.IfthePremierwithBuy

back option does not apply to your plan, you do not have the option to restore any

reducedorcancelledDeathcover.

reinstated trauma cover

TheIndexationfeatureandGuaranteedfutureinsurabilityarenotapplicableonthe

Reinstated Trauma cover.

We will not pay a claim for the Reinstated Trauma cover if:

•theinsured person was diagnosed or suffered symptoms leading to diagnosis of a

new trauma conditionthatbecameapparentoroccurredintheintervening13month

periodpriortothedateofreinstatementoftheTraumacover(andwereceiveyour

completed application form and first premium),or

•thenewtrauma condition is the same as the original trauma condition or is directly

or indirectly caused or related to the trauma condition for which the original trauma

cover was paid, or

•thenewtrauma condition is directly or indirectly related to the treatment used for the

original trauma condition, or

THESE WORDS AND


• BUYBACK

• CERTIFICATEOF

INSURANCE

• INSUREDPERSON

• PlAN

• PREMIUM

• REINSTATEDTRAUMA

COVER

• TRAUMACONDITION


OUTINRUlE40.


•thetrauma condition is Kidney failure or a Heart condition* and the original trauma

cover payment was for systemic lupus erythematosus, or

•the trauma condition is a Heart condition* and the original trauma cover payment was

also for a Heart condition*, or

•thetrauma conditionisaStrokeorParalysis**(directlyorindirectlyresultingfroma

stroke)andtheoriginaltraumacoverpaymentwasforaHeartcondition*.

* Heart condition means any of the following definitions: aortic surgery, cardiomyopathy, coronary artery angioplasty – triple vessel, coronary artery surgery, heart attack – myocardial infarction, heart attack – outofhospitalcardiacarrest,heartvalvesurgery,majororgantransplant(heartonly),openheartsurgery,primary pulmonary hypertension.

** Paralysis means any one of diplegia, hemiplegia, paraplegia, quadriplegia or tetraplegia.

Wewon’tpayabenefitundertheReinstated trauma cover for a trauma condition for

whichwehavealreadypaidatraumabenefit.

Wewon’tpayabenefitundertheReinstated trauma cover for a trauma condition

unlessacceptableevidenceisprovidedthatthenew trauma condition is:

•independentof,andtotallyunrelatedtothepreviouslypaidtrauma condition, and

•totallyunrelatedtothetreatmentusedfortheoriginaltrauma condition for which we

paid.

Wewon’tpayabenefitundertheReinstated trauma cover for any conditions or

symptomsthatbecomeapparentorarediagnosedbeforethedateofreinstatementofthe

trauma cover.

exAMPle

MichaelownsaFlexibleLifetime–Protectionplanunderwhichheisaninsured person.

He has:

TraumacoverPremierof$400,000.HehasalsoselectedtheTraumaReinstatementoption.

if he suffers a trauma condition,wewillpayhim$400,000,andhisTraumacoverwill

cease. one year after we pay the claim, Michael can exercise the trauma reinstatement

option and have Reinstated Trauma coverof$400,000.

THESE WORDS AND


• INSUREDPERSON


COVER

• TRAUMACONDITION


OUTINRUlE40.


Whenwewon’tpay

THESE WORDS AND


• CERTIFICATEOF

INSURANCE

• CPI

• INSUREDPERSON

• PlAN

• TERMINAllYIll

• TOTAllYAND

PERMANENTlYDISABlED

• TOTAllYDISABlED

• TRAUMACONDITION


OUTINRUlE40.

Rules12and13alsoapplytoanyclaimsunderChildren’sTraumacover.

12.

on PurPose Wewon’tpayiftheinsured person’s trauma condition or the insured person

becoming totally and permanently disabled or totally disabled was caused directly or

indirectlybyanintentionalordeliberateactbyyou,ortheinsured person.

13.

DEATH–ORTERMINALILLNESS– Wewon’tpayiftheinsured persondies(orbecomesterminally ill)bytheirownhand

BYOWNHAND withinoneyearand30daysofthedatetheDeathcoverstartsorrestarts(respectively).

that date is shown on the Certificate of Insurance or in the document in which we told

youthatwehaverestartedtheDeathcoverorplan.

Also,ifwehaveincreasedtheamountoftheDeathcoverforaninsured personbecause

youaskedusto,andwithinoneyearand30daysaftertheincrease,thatinsured person

dies–orbecomes terminally ill–bytheirownhand,wepaytheamountthatapplied

beforetheincrease.Thatoneyearand30dayperiodstartsonthedatefromwhichthe

increase applies. that date is shown in the document in which we told you that we have

increasedtheDeathcover.

if your plan replaces a previous planissuedbyus,oranotherinsurer,theoneyearand

30dayperiodwon’tapply.Ifyouwouldhavebeenentitledtoclaimundertheprevious

plan, provided:

•thepreviousplan was in force at the time AMP issued this plan, and

•thepreviousplanwasinplaceforatleastoneyearand30days.

Wewillrequiresatisfactoryevidenceoftheabovepointsatthetimeofanyclaimforthisto

apply.

Note,itdoesn’tmatterwhetherthe insured person was sane or insane when they

becameterminally ill or died.

this restriction does not apply to regular CPI increases.

14.

CHILDREN’STRAUMACOVER Wewon’tpayifan insured person’s trauma conditioniscauseddirectlyorindirectlyby

any congenital condition.

Wewon’tpayifaninsured person’s trauma condition or death is caused directly or

indirectlyby:

•alcoholordrugs,or

•anybodywhoisconnectedtotheinsured person, or to either of their parents, or to a

de facto spouse of either parent.


IncreasingbenefitsbytheCPI

15.

INDEXATIONFEATURE each year, on the plan anniversary, we will increase the amount of an insured person’s

coverbyanyincreaseintheCPIor5%,whicheverishigher,unlessweagreednottowhen

that cover started.

TheseincreaseswillbeclearlyidentifiedintheAnnualStatementwesendyoueachyear.

increasing an insured person’s cover makes the premium increase.

Ifyoudon’twantthisincrease,infullorinpartthenyouneedtotellus.

Note:wedon’tincreasethefollowing:

•the$10,000DeathcoverunderChildren’sTraumacover

•reinstated trauma cover issued as a result of exercising the trauma reinstatement

option(seeRule11.3)

•deathcoverissuedasaresultofexercisingtheBuybackoption(seeRule11.2).

15.1

cPi increAses stoP At A certAin AGe the last time we increase an insured person’scoverbyanyincreaseintheCPI is on the plan

anniversaryon,orbefore,theinsured personreachestheageshowninthetablebelow.

Type of cover Age limit

trauma cover – adults 75

TerminalIllnessbenefit 75

Deathcover 75

TPDcover 75

You can decline cPi increases

We make increases under the indexation feature automatically. However, you can ask us:

•toincreasetheamountofsomeorallofaninsured person’scoverbyonlysomeofthe

increaseavailableundertheindexationfeature,or

•nottoincreasetheamountofan insured person’s cover at all, or

•nottoincreasetheamountofan insured person’s cover ever again.

Ifyouwantustodoanyofthesethings,youneedtotellus,inwriting,beforeyoupay

the premium that falls due on the plan anniversary from which the increase under the

indexation feature is to apply.

Youcansubsequentlyaskustomakeincreasesundertheindexationfeaturetothatcover

for that insured person again.

We may agree to do this.

THESE WORDS AND


• BUYBACK

• CPI

• INSUREDPERSON

• PlAN

• PlANANNIVERSARY


COVER


OUTINRUlE40.


THESE WORDS AND


• CERTIFICATEOF

INSURANCE

• HOMEDUTIES

• INSUREDPERSON

• OWNOCCUPATION

• PlAN

• REGUlARREMUNERATIVE

WORK

• TOTAllYAND

PERMANENTlYDISABlED



OUTINRUlE40.

When the plan and cover start and end

16.

WHENTHEPLANANDCOVERSTART When we accept your application for insurance we will send you a Certificate of

Insurance showing you the details of your insurance and the date your plan commenced.

While most cover for an insured person starts on the date shown in the Certificate of

Insurance, cover for some trauma conditions is delayed. this is explained in rule 3.1 for

TraumacoverPremierandStandardandrule7.1.forChildren’sTraumacover.

the CertificateofInsurance shows the dates on which each type of cover for each

insured person starts.

17.

WHENTHEPLANANDCOVEREND each type of cover for an insured person ends on the first of the following dates:

•whenwepayyouforthatinsured person for that type of cover. this is explained in rule

11, or

•whenwereducetheamountofthattypeofcovertozeroforaninsured person

becausewepayyouunderanothertypeofcover.Thisisexplainedinrule11,or

•onthedateshownintheCertificate of Insurance for that insured person for that

type of cover, or

•ifyouchangeyourplan in a way that ends that type of cover for that insured person, or

•iftheinsured person dies, or

•whentheplan ends.

the insured person’s cover ends when the plan ends. the plan ends as soon as one of

the following happens:

•allcoverforthelastremaininginsured person ends, or

•youwritetousandaskustoendtheplan, or

•weendtheplan under rule 17.1.

note, if an insured personwhoiscoveredbyTPDcoverstopsperforminghome

duties, or regularremunerativework or their own occupation, the circumstances

in which we would pay under that type of cover are very narrow. this is explained in

the definition of totally and permanently disabledinrule40.


THESE WORDS AND


• INSUREDPERSON

• MONTHS

• PlAN

• PREMIUM


OUTINRUlE40.

17.1

WHENWECANENDTHEPLAN to keep the plan going, you must pay the premium on time. We can end the plan if you

don’tdothis.However,ifyoudon’tpayontime,youhaveanextra30daystopaybefore

we take steps to end the plan.Ifyouhaven’tpaidontime,wewillwriteandremindyou.

18.

REFUNDOFPREMIUMS if you end the plan during a period for which you have already paid the premium, we

refund the premium less the plan fee, stamp duty and government charges – for any

unused complete months.Wedon’trefundpremiums if the plan ends for any other

reason.

exAMPle

if you have paid a yearly premiumof$1,200,andyouendtheplan nine months later,

werefund$300.

For superannuation plans we will pay this refund into a similar complying superannuation

fundthatyounominate,ortoanaccountintheAMPEligibleRolloverFund(ERF)onyour

behalf.

restArtinG tHe PlAn if you end the plan, you can ask us to restart it. but you

must ask us in writing within 12 months of it ending.

if we end the planbecauseyoudon’tpayontime,you

can ask us to restart it. but you must ask us in writing

within 12 months after the due date of the premium you

didn’tpay.

to restart the plan, you must:

•payusonepremium, and

•giveusanyinformationwerequireaboutanyinsured

person.

We may then agree to restart the plan.


THESE WORDS AND


• INSUREDPERSON

• PlAN

• PlANANNIVERSARY

• PREMIUM


OUTINRUlE40.

Guaranteed continuation of cover

Keeping you informed

19.

We GuArAntee to continue Your PlAn if you pay your premium on time and the cover is still current, we guarantee:

•tokeepthecoverforeach insured person going on the same rules each year, and

•nottocancelit–oranypartofit.

20.

WESENDYOUANANNUALSTATEMENT each year, we will send you an Annual statement. it will set out:

•thenameofeach insured person, and

•thetypesofcoveryouhaveforeachinsured person, and

•theamountofcoverafteranyregularincreaseundertheindexationfeature,and

•thepremium you have to pay to keep the plan going.

WewillsendyoutheAnnualStatementjustbeforeyourplan anniversary.

this provides an opportunity for you to speak to your financial planner, or us, and

review and update your insurance needs.


THESE WORDS AND


• BUYBACK

• INSUREDPERSON

• lINKED

• PlAN

• PREMIUM

• PREMIUMRATES

• SPECIAlRUlE

• STANDAlONE


OUTINRUlE40.

changing your plan

21.

You cAn cHAnGe Your PlAn You can change your plan in the following ways without needing to give us more details

aboutthe insured person’s health, occupation, or pastimes. this applies even if the

insured person’s health gets worse, or they change their occupation, or pastimes.

For example you can:

•changethelevelofcoverfromTraumacoverPremiertoTraumacoverStandard,or

•changean insured person’s type of cover from Stand alone to linked, or

•removetheBuyback option.

However:

•ifyoutransferatypeofcover,wemayrequireyoutotransferallofthattypeofcover

that applies to that insured person under this plan to the new plan. For linked cover,

we reduce the amount of any other remaining cover for that insured personbythe

amount you transferred, and

•the insured personmustbeunder70whenyoumakethechange,and

•thenewpremium, the new amount of cover, and the insured person’s age, must each

meetanynormalrequirementswehave(atthetimeyouchange)fortheplan or cover

which you change to.

Note,youcan’tmakeanyofthesechangesifaspecial rule applies to that insured person.

21.1

AutoMAtic PlAn enHAnceMents We review our insurance plans regularly. if we enhance our definitions or product features

without:

•changingthepremium rates or

•changingexistingpremium discounts, or

•chargingextrapremiums,

wewillautomaticallyprovideyouenhancementsforwhichyouareeligibleatnocharge.

Ifwemakeachangethatisnotanenhancementthesewon’tautomaticallyapplytoyour

plan.

Wewillwritetoyouandadviseyouofthechangesshouldautomaticenhancementsbe

made.

Note,youmaybeabletomakeotherchangestotheplan. For example, you can add

an insured person to this plan, or increase a type of cover. However, we will need

detailsabouttheinsured person’s health, occupation and pastimes. We suggest you

speaktoyourfinancialplanner,orus,aboutanychangesyouwouldliketomakeand

whatourrequirementswillbe.


THESE WORDS AND


• CARER

• INSUREDPERSON

• MONTH

• PlAN

• PREMIUM


OUTINRUlE40.

21.2

GUARANTEEDFUTUREINSURABILITY You may increase an insured person’s Deathcoverand/orTPDcoverand/orTraumacover

without providing any evidence of health if:

•theinsured person marries, or

•the insured person divorces, or

•the insured person’s childisbornortheylegallyadoptachild,or

•theinsured person’s child starts school, or

•theinsured personisgrantedahousingloanbyafinancialinstitutiontobuytheirfirst

home, or

•theinsured person completes their first undergraduate degree at a recognised

Australian university, or

•theinsured personbecomesacarer for the first time.

You must apply for the increase within 12 months of the date the event occurs. You must

provideappropriateproofoftheevent,thatisacceptabletous,suchascertificationofthe

event or a statutory declaration. Premiumswillbebasedontheratesapplicableatthe

time of exercising this feature.

You can only increase the insurance cover amount once under this feature in any 12 month

period.Eachtime,youmayincreasetheinsurancecoveramountby25%oftheoriginal

suminsuredor$250,000,whicheveristhelesser.

ThemaximumtotalamountbywhichyoucanincreasetheDeathcoverunderthisfeature

over the life of the plan is the lesser of:

•theinitialamountofDeathcoverundertheplan(excludingincreasesunderthe

indexationfeatureandincreaseseffectedunderGuaranteedFutureInsurability),and

•$1,000,000.

ThemaximumtotalamountbywhichyoucanincreasetheTPDcoverand/orTraumacover

under this feature over the life of the plan is the lesser of:

•theinitialamountofTPDand/orTraumacoverundertheplan(excludingincreasesunder

theindexationfeatureandincreaseseffectedunderGuaranteedFutureInsurability),and

•$250,000.

ThemaximumamountyoucanincreaseTPDcovertounderthisfeatureis$2.5million.The

maximum amount you can increase trauma cover to under this feature is $2 million.

ThisfeatureisnotavailableforChildren’sTraumacover.


Youcan’texercisethisfeatureifatthetimeofyourrequest:

•theinsured personisolderthan55yearsofage,or

•the insured person’s plan has a premium loading or special terms, or

•theinsured person’s premiumsarebeingwaivedunderthewaiverofpremiumoption,or

•the insured personiseligibletomake,orhasmadeaterminal illness,TPDortrauma

claim under any plan that the insured person holds with AMP.

THESE WORDS AND


• INSUREDPERSON

• PlAN

• PREMIUM

• TERMINAlIllNESS


OUTINRUlE40.


THESE WORDS AND


• CERTIFICATEOF

INSURANCE

• INSUREDPERSON

• PlAN

• PlANANNIVERSARY

• PREMIUM

• PREMIUMRATES


OUTINRUlE40.

Premium – what you have to pay

22.

HOWMUCHANDWHEN the amount of the premium when the plan starts, and when the premium falls due, are

bothshownintheCertificate of Insurance.

We recalculate the premiumeachyear.Atthattime,webaseitontheageofeach

insured person and the cover that applies to them. We use the premium rates, loadings,

discounts,andplanfees(andanygovernmentchargeslikestampduty)thatapplyatthat

time. We show you the recalculated premium in the Annual statement. We send this just

beforetheplan anniversary.

22.1

GOVERNMENTTAXES,DUTIES You have to pay us any government taxes, duties, or charges relating to the plan.

ANDCHARGES We will include these amounts in the amount of the premium when we tell you how

much the premium is.

if you change the plan, it is likely that the premium will change. After any change, we

will inform you of the change and the amount of the new premium in writing.


THESE WORDS AND


• INSUREDPERSON

• MONTHS

• PlAN

• PlANANNIVERSARY

• PREMIUM

• PREMIUMRATES


OUTINRUlE40.

23.

PreMiuM GuArAntee We guarantee not to increase the premiumbetweenplan anniversaries, unless:

•youchangeyourplan in a way which increases the premium, or

•thegovernmentintroducesanewtax,duty,orcharge,orchangesanexistingone.

23.1

PREMIUMRATESANDDISCOUNTS We can change premium rates and discounts, and withdraw discounts and loadings, in

NOTGUARANTEED thefuture,astheyaren’tguaranteed.However,ifwedothatforthisplan, the changes

willapplytoallFlexibleLifetime–Protectionplans that are similar to this one.

Additionally if we do that for an insured person, it will apply to all people we insure

underFlexibleLifetime–Protectionplans that are similar to this one, for example people:

•whoareinthesameAMPLifeinsuranceratingcategoryasthatpersonatthattime,or

•whohavesimilarcovertothatperson,or

•whoarepartofaspecialarrangementwehaveestablishedwiththeiremployer,

professional affiliation, or similar type of association.

However, if we have given you an individual discount on your premiums, we may remove

this discount at any time.

if we do anything which changes the premium for the plan or for an insured person, we

willtellyouaboutthechange,andtheamountofthenewpremium,beforeitapplies.

KeePinG tHe PreMiuM if you want to keep the premium the same for the next

tHe sAMe 12 months as it was for the last 12 months, you need to

askustodothis,inwriting,beforetheplan anniversary

from which you want the premium to stay the same.

You must also tell us what cover you want reduced or

cancelled, to keep the premium the same.

You need to ask us to do this each year that you want it

to happen.

note, we may not agree to do this in the future.


THESE WORDS AND


• CERTIFICATEOF

INSURANCE

• CPI

• INSUREDPlAN

• PlAN

• PlANANNIVERSARY

• PREMIUM

• PREMIUMRATES


OUTINRUlE40.

24.

IFWEREDUCEOURPREMIUMRATES if we reduce our premium rates, or we increase any discounts, we may keep your

premiumthesamebyincreasingtheamountofcoverundertheplan. if we do that, we

willtellyouinwritingbeforetheplan anniversary from which the change applies and

you agree to the change when you pay the next premium.

Ifyoudon’twantthechange,pleasetellusinwriting.

25.

PlAn Fee there is a plan fee for each insured person. that fee is included in your premium.

if there is more than one insured person under the plan, the plan fee is lower for the

second and following insured persons.

each year, we increase the planfeebyanyincreaseintheCPI. However, it stays the same

if the CPI is negative.

26.

PreMiuM FreQuencY Fee if you pay more often than yearly, we charge an extra fee. that fee is included in your

premium. it is a percentage of your premium. We can change the percentage we use to

calculate the increase at any plan anniversary.

27.

DISCOUNTS We have a range of discounts which may apply to you. the premium shown in the

Certificate of Insurance and Annual statement is the premium after any discounts have

beenapplied.


THESE WORDS AND


• CERTIFICATEOF

INSURANCE

• INSUREDPERSON

• PlAN

• PREMIUM

• TERMINAllYIll

• TOTAllYDISABlED


OUTINRUlE40.

Whenyoudon’thavetopaypremiums

28.

iF We PAY You You do not have to pay the premium for an insured person:

•ifwehavepaidbecausethat insured person is terminally ill, or

•ifyouhavetheWaiverofPremiumoption–seerule29.

29.

WAiVer oF PreMiuM

TherearetwotypesofWaiverofPremiumavailableunderthisplan. However, you can add

only one type to your plan.

ThetwotypesofWaiverofPremiumavailableare:

individual life

•youdon’thavetopaythepremium for one or more insured persons while they are

totally disabled. this is explained in rule 29.1, or

Nominatedlife(doesn’tapplytoSuperannuationplans)

•youdon’thavetopayanypremium under the plan while a particular insured person

is totally disabled. this is explained in rule 29.2.

the Certificate of Insurance shows whether you have the Waiver of Premium option.


29.1

WAiVer oF PreMiuM oPtion – if an insured personhasbeentotally disabled for at least six monthsbeforetheyturnage

INDIVIDUALLIFE 60,youdon’thavetopayanymorepremiums for that insured person and their cover

continues. in addition, the premium you paid during the six months while we determined

if the insured person was totally disabledwillberefundedtoyou.

For superannuation plans we will pay this refund into a similar complying superannuation

fundthatyounominate,oranaccountintheAMPEligibleRolloverFund(ERF)onyour

behalf.

You have to start paying the premium for that insured person again on the first of the

following dates:

•assoonasthat insured person stopsbeingtotally disabled, or

•thedateDeathcoverceasesfortheinsured person, or

•theplan anniversary on or after the insured person’s70thbirthday,or

•theterminationoftheplan.

Thistypeofoptionisavailableforoneormoreinsured persons covered under this plan.

if there is more than one insured person, we calculate the amount of the plan fee we

willwaivebydividingthetotalplanfeebythenumberofinsured persons.

29.2

WAiVer oF PreMiuM oPtion – Thisisnotavailableinsuperannuationplans.

NOMINATEDLIFE if you have selected this option only one “nominated” insured personiscoveredby

theWaiverofPremiumoption.Ifthatpersonhasbeentotally disabled for at least

six monthsbeforetheyturnage60,youdon’thavetopayanymorepremium under

this plan even if there are other insured persons on the plan and they are not totally

disabled. in addition, the premium you paid during the six months while we determined

if the insured person was totally disabledwillberefundedtoyou.

You have to start paying the premium on the plan again on the first of the following dates:

•assoonasthenominatedinsured personstopsbeingtotally disabled, or

•thedateDeathcoverceasesforthenominated insured person, or

•theplan anniversary on or after the nominated insured person’s70thbirthday,or

•theterminationoftheplan, or

•ifthatinsured person dies.THESE WORDS AND


• INSUREDPERSON

• MONTH

• PlAN

• PlANANNIVERSARY

• PREMIUM

• TOTAllYDISABlED


OUTINRUlE40.


THESE WORDS AND


• DOCTOR

• INSUREDPERSON

• PREMIUM

• TRAUMACONDITION


OUTINRUlE40.

How to make a claim

30.

WHATTODO to make a claim you need to contact us. We will send you a claim form to fill in and return

tous.Youmustalsodoeachofthethingssetoutinrules30.1to30.3.

Wecanaskfortheinformationdescribedinthoserules:

•whileweareassessingtheclaim,and

•whileyouarenotpayingthepremiumbecausewearewaivingyourpremium. in that

case, we can ask for it as often as we need it.

30.1

HEALTHANDOTHERINFORMATION For you to give us that information, you must give us any documents and information

whichwereasonablyrequireabout:

•aninsured person’s health, and

•thecircumstancessurroundingtheirhealthproblems,and

•anythingelserelatedtotheclaim.

You must pay the costs of getting information from the insured person’s doctors and

advisers. However, we will pay the costs of getting information from advisers and medical

specialists we choose.

An insured person suffers a trauma condition if they meet the description shown in

rule 39. usually, we will ask an appropriate consultant medical specialist who specialises

inthediagnosis,rehabilitationortreatmentofthat trauma condition to confirm that

the insured person meets that description. For example, we usually ask a neurologist to

confirm that the insured personhassufferedastrokeasdescribedinrules3and39.

30.2

AGEANDIDENTITY You must prove the insured person’s age and identity.


31.

tiMe liMits You must tell us that you are going to make a claim. You must do that within the relevant

timeperiodshowninthetablebelow.

You must give us all information which we ask for within six months after you tell us in

writing that you are going to make a claim.

Type of claim How soon you must tell us that you are

going to claim

An insured person suffers a trauma

condition.

Within 12 months of the insured person

suffering the trauma condition.

An insured person is totally and



suffering the illness or injury which causes you

tomakeaclaimbecausetheyare totally and


An insured person is totally

disabled and you want to make a

claim under the Waiver of Premium

option.


beingtotally disabled.

An insured person is terminally ill. Notimelimit–butthesooneryoutellus,the

sooner we can pay.

An insured person dies. Notimelimit–butthesooneryoutellus,the

sooner we can pay.

32.

LATECLAIMSANDRESPONSES Ifyoudon’tmeetthesetimelimitsandwehavebeenprejudicedbythedelay,wewill

reduce the amount we pay to compensate us for the prejudice we have suffered.

THESE WORDS AND


• INSUREDPERSON

• MONTH

• TERMINAllYIll

• TOTAllYAND

PERMANENTlYDISABlED

• TOTAllYDISABlED

• TRAUMACONDITION


OUTINRUlE40.

However, we may extend those periods if you ask us.


Miscellaneous

33.

OWNERSHIPANDTRANSFERs You can transfer the ownership of the plan if it is a non-superannuation plan.

to transfer ownership:

•youmustcompletethetransferformonthelastpageoftheCertificate of Insurance

we sent you when the plan started and send it to us, and

•youmustsendusthat Certificate of Insurance, and

•weregisterthetransfer.

After the transfer, we will communicate only with the new plan owner.

34.

GoVerninG lAW this planisgovernedbytheLifeInsuranceAct1995,andtheInsuranceContractsAct

1984.

35.

AustrAliAn $ All amounts under this planmustbepaidinAustraliandollars.

36.

OURLIABILITYISLIMITED the assets of our no. 1 statutory Fund – or any other fund of which this plan forms part

at the time – are the only assets we will use to pay you under this plan.

37.

no sHAre oF ProFits this is a non-participating plan. that means it does not entitle you to share in any profits

of AMP life.

38. Thisrulehasbeenremoved

THESE WORDS AND


• CERTIFICATEOF

INSURANCE

• PlAN

• PlANOWNER


OUTINRUlE40.


39.

DESCRIPTIONSOFTRAUMACONDITIONS

Alzheimer’sdiseaseandotherdementias

DESCRIPTION Wewillpayifaninsuredperson’sbrainfunctionfailssignificantlyandpermanently.The

failure must cause the insured person to:

•beunabletoperformanyoneoftheactivitiesofdailylivingwithoutassistancefrom

someone else, or

•requiredailycareonanongoingbasis.

Wewon’tpayifthedementiaisdirectlycausedbyalcoholordrugabuse.

GlossArY oF terMs

Activities of Daily Living – Seerule40forthedefinition.

Dementia – Progressivementaldeteriorationduetoorganicdiseaseofthebrain.

trauma definitions and descriptions

Tosatisfythesedefinitionsanddescriptionsyoumustsurvivefor14days.

claims Guiding statement

Medical diagnoses and investigation methods used in many of the trauma conditions that we cover are advancing at a rapid rate.

Someofthesenewdiagnosticmethod(s)mayprovetobetterdefineaparticulartrauma condition.Shouldyoubediagnosedwith

one of the trauma conditions,andthediagnosticmethod(s)usedisn’tspecifiedwithinthetraumadefinition,wemaytakethe

method(s)intoconsideration,whichmayassistyouintheassessmentofyourclaim.

THESE WORDS AND


• TRAUMACONDITION


OUTINRUlE40.


Aortic surgery

DESCRIPTION Wewillpayifaninsuredpersonhassurgeryperformedtocorrectastructuralabnormality

ofthethoracicorabdominalaorta.Intheopinionofanappropriateconsultantmedical

specialist,thetreatmentmustberequiredonmedicalgroundsandmustbethemost

appropriatetreatment.Wewon’tpayforsurgeryperformedusingintraluminalor

laparoscopic techniques.

GlossArY oF terMs

Aorta – Themainarteryarisingfromtheheartwithbranchestoeverypartofthebody.

Intraluminal techniques – Thetreatmentofinternalabnormalitiesbymeansofacatheterinsertedthrougha

superficialbloodvesseltoapplycertaintechniques,andnotinvolvinganopensurgical

operation.

Catheter – Ahollowtube.

Aplastic anaemia

DESCRIPTION Wewillpayifaninsuredpersonhassevereaplasiaofbonemarrowasdefinedbyan

appropriate consultant medical specialist.

GlossArY oF terMs

Aplasia – Failureofthebonemarrowtoproducebloodcells.

Aplastic anaemia – Asevereformofanaemiacausedbyaplasiaofthebonemarrow.

bacterial meningitis

DESCRIPTION Wewillpayifaninsuredpersonsuffersbacterialmeningitiscausedbyaprovenorganism.

the meningitis must produce neurological deficit causing permanent and significant

functional impairment.

GlossArY oF terMs

Meningitis – Inflammationofthecoveringofthebrainandspinalcord.

Neurological deficit – Abnormalitiesofthenervoussystemproducingcertainsymptomsandresultingindisorders

of function.


Benigntumourofthebrainorspinalcord

DESCRIPTION Wewillpayifaninsuredpersonhasanon-canceroustumourinthebrainorspinal

cordwhichishistologicallydescribedandwhichproducesneurologicaldeficitcausing

permanent and significant functional impairment or requires radical surgery for its removal.

Wedon’tcoveranyofthefollowing:

•cysts,granulomasandcerebralabscesses,or

•malformationsin,orof,thearteriesorveinsofthebrain,or

•haematomas,or

•tumoursinthepituitarygland.

GlossArY oF terMs

Benign tumour – An enlargement or swelling due to overgrowth of tissue which pushes aside normal tissue

butdoesn’tinvadeit.

Cerebral abscess – Alocalisedcollectionofpusoccurringinthebrain.

Cyst – Asacorcapsulecontainingliquidorsemi-solidsubstance.

Granuloma – Amassoftissueoccurringinreactiontothepresenceof,forexample,aforeignbodyor

bacterialinfection.

Haematoma – Amassproducedbyacoagulationofbloodinatissueorcavity.

Histologically described – A conclusion reached after a microscopic examination of cells.


of function.

Pituitary gland – the master gland of the endocrine system which controls hormone production of other

endocrine glands.

blindness

DESCRIPTION Wewillpayifaninsuredpersonlosesthesightofbotheyestotheextentthatvisualacuity

is6/60orlessinbotheyes,ortotheextentthatthevisualfieldisreducedtotendegrees

orlessofarc.Thatlossmustbeirreversibleandunabletobecorrectedbyglassesorany

other means.

AMP Flexible liFetiMe – Protection – PlAn rules –41

cancer

DESCRIPTION Wewillpayifaninsuredpersonsuffersamalignanttumour,malignantsarcoma,Hodgkin’s

lymphoma,non-Hodgkin’slymphoma,malignantbonemarrowdisorderorleukaemiawith

theexceptionofchroniclymphocyticleukaemia,BinetstagesAandBorRaistages0,Iand

ii. We only pay for chronic lymphocytic leukaemia rai stages i or ii if the insured person

isdiagnosedundertheageof45.Thecancermustbeconfirmedbypathologytestsand

characterisedbytheuncontrolledspreadofmalignantcellsandtheinvasionofnormal

tissue.

Wewon’tpayforanyofthefollowing:

•skincancersotherthanmelanoma,or

•melanomawherethethicknessislessthan1.5mmandtheClarklevelofinvasionisLevel

1 or 2, or

•prostatictumourswhichareequivalenttoorlessthanTNMClassificationT1anda

Gleasonscoreoflessthan8(note,wewon’tconsidertheGleasonscoreforprostatic

tumourswhichareequivalenttoormorethanTNMClassificationT2),or

•tumourswhicharehistologicallydescribedaspre-malignantorshowingmalignant

changes of “carcinoma in situ” and not requiring radical surgery, or

•HIV/AIDSrelatedcancers.

GlossArY oF terMs

Binet/Rai stages – Classificationofchroniclymphocyticleukaemiawhichdescribesdiseaseprogression.

Bone marrow disorders – Lifeshorteningdisorderofbonemarrowelements.

Carcinoma in situ – Cancerconfinedtoitssiteoforiginandreadilycurable.

Chronic lymphocytic leukaemia – A form of leukaemia that is usually only life threatening in its advanced stages.

Clark Level – Aclassificationsystemdescribingthedepthofinvasionofamelanomapastthetoplayers

oftheskin.Theclassificationsarefrom1to5.

Gleason score – A grading method assigned to indicate how aggressive the tumour is.

Histologically described – A conclusion reached after a microscopic examination of cells.

Hodgkin’s lymphoma and

non-Hodgkin’s lymphoma – Sometimestreatablemalignantdiseasescausingenlargementofthelymphnodesandspleen.

Leukaemia – Amalignantdiseaseofthebonemarrow,wherethereisimpairmentofformationof

maturebloodcells.Thisimpairmentcanbemanifestedinbleedingandbruising,serious

infection and symptoms of anaemia such as tiredness and fatigue.

Malignant bone marrow disorders – Malignantdiseaseinthebonemarrowduetotumourspreadfromotherorgansordue

totumoursarisingfromtheblood-formingcellsresultinginlifethreateningeffectsonthe

maturebloodcells.


Melanoma – A malignant tumour of the skin, usually developing from a mole.

Sarcoma – Amalignanttumouroftissuessuchasbone,muscleorligament.

TNM classification – Aclassificationsystemdescribingtheextentoflocalinfiltrationandspreadtoglandsor

otherpartsofthebody.

Cancer(Partial)

DESCRIPTION We will pay if an insured person suffers carcinoma in situ of the vulva, vagina or fallopian

tubes,wherethetumourisclassifiedastumourinsitu(Tis)accordingtotheTNM

classification system.

We will pay:

•$10,000,or

•10%ofthesuminsured(subjecttoamaximumof$25,000),

whichever is higher.

if we pay under this particular trauma condition, the cover for other trauma conditions the

insuredpersonhasonthisplancontinues,butthecontinuingamountofcoverisreduced

bywhatwepaidunderthiscondition.Yourpremiumisalsoreducedaccordingly.

We pay under this definition only once.

GlossArY oF terMs

Carcinoma in situ – Cancerconfinedtoitssiteoforiginandreadilycurable.



cardiomyopathy

DESCRIPTION Wewillpayifaninsuredperson’sheartmusclefailstofunctionproperlyresultingin

permanent physical impairment to at least class 3 of the new York Heart Association

classification of cardiac impairment.

Wewon’tpayforcardiomyopathythatisdirectlycausedbyalcohol,orrelatedtodruguse

thatisnotprescribedbyadoctor.

GlossArY oF terMs

New York Heart Association

Classification of Cardiac Impairment – Afunctionalclassificationtoassesscardiovasculardisability.

Class 3 – Physicalimpairmentconstitutedbyamarkedlimitationofphysicalactivity.Theinsured

personwillbecomfortableatrest,butlesswhileengaginginordinaryactivity.


coma

DESCRIPTION Wewillpayifaninsuredpersonisinastateofunconsciousnessanddoesn’treactto

externalstimuli.Thestateofunconsciousnessmustscore6orlessontheGlasgowComa

scale.

the state of unconsciousness must either:

•becontinuousforatleast4days,followedbynewfunctionalimpairmentproducing

neurologicalsignswhichlastatleastafurther14days.Thesignsmustbedemonstrated

clinicallyandbyacerebralCTscan,angiogram,MRI,PET,oranyotherreliableimaging

techniqueapprovedbyAMP,or

•becontinuousforatleast90days.

Inallcircumstances,wewon’tpayforanycomathatis:

•causedbytheinsuredperson’salcoholordrugabuse,or

•theresultoftheinsuredpersonsufferinganothertraumaconditionforwhichwepay.

GlossArY oF terMs

Glasgow Coma Scale – bedside assessment of levels of consciousness.

Coronaryarteryangioplasty(Partial)

DESCRIPTION We will pay if an insured person undergoes angioplasty involving less than 3 coronary

arteriesduringthesameprocedure(withorwithouttheinsertionofastent,lasertherapyor

atherectomy).Intheopinionofanappropriateconsultantmedicalspecialist,thetreatment

mustberequiredonmedicalgroundsandmustbethemostappropriatetreatment.

We will pay:

•$10,000,or







GlossArY oF terMs

Angioplasty – Thetreatmentofaninternalabnormalitybytheinflationofaballooncatheterinserted

through a superficial artery and not involving an open surgical operation.

Coronary artery – Vesselconveyingbloodtotheheartmuscle.


coronary artery angioplasty – triple vessel

DESCRIPTION Wewillpayifaninsuredpersonundergoesangioplastyofthecoronaryarteries(with

orwithouttheinsertionofastent,lasertherapyoratherectomy)to3ormorecoronary

arterieswithinthesamesurgicalprocedure.Angiographicevidence,indicatingobstruction

of 3 or more coronary arteries, is required to confirm the need for this procedure. in the

opinionofanappropriateconsultantmedicalspecialist,thetreatmentmustberequiredon

medicalgroundsandmustbethemostappropriatetreatment.

GlossArY oF terMs


through a superficial artery and not involving an open surgical operation.


coronary artery surgery

DESCRIPTION We will pay if an insured person has coronary artery disease and as a result has surgery

involvingbypassgraftstooneormorecoronaryarteries.Intheopinionofanappropriate

consultantmedicalspecialist,thetreatmentmustberequiredonmedicalgroundsandmust

bethemostappropriatetreatment.

Wedon’tpayunderthisparticulartraumaconditionforproceduressuchasangioplasty,

laser and intra-arterial techniques or other non-surgical procedures.

GlossArY oF terMs


throughasuperficialbloodvesselandnotinvolvinganopensurgicaloperation.


Coronary artery disease – Significantnarrowingorblockageofthecoronaryarteries.

encephalitis

DESCRIPTION Wewillpayifaninsuredpersonisdiagnosedashavingencephalitisbyanappropriate

consultantmedicalspecialist.Theinsuredpersonmusthaveimpairedbrainfunctionwhich

causespermanentinabilitytoperformanyoneoftheactivitiesofdailylivingwithout

assistance from someone else.

Wewon’tpayforencephalitiscauseddirectlyorindirectlybyHIV/AIDS.

GlossArY oF terMs


Encephalitis – Infectionofthebraincausinginflammation.


Heart attack – myocardial infarction

DescriPtion We will pay if part of an insured person’s heart muscle dies as a result of inadequate blood

supply to the relevant area. An appropriate consultant medical specialist must certify that a heart

attack has occurred and provide confirmatory evidence of this by the following test results:

•newelectrocardiographicchangesconsistentwithmyocardialinfarction,and

–abnormalbiomarkerssuchasacardiacenzymeriseabovetheupperlimitofnormal,or

– a rise of troponin i above 2.0 ng/ml or troponin t above 0.6 ng/ml.

Ifontheabovecriteria,aheartattackisconfirmed,buttheresultsarebelowthelimits

indicated,thefollowingwillbeconsideredasdiagnosticevidence:

•abnormalwallmotionasassessedbyechocardiography,or

•reductionofleftventricularejectionfractionto50%,orless

where either of the above is confirmed at least 6 weeks after the cardiac event.

Wewon’tpayforothercausesofseverenon-cardiacchestpain,heartfailureorangina.

GlossArY oF terMs

Abnormal wall motion – An area of dead heart muscle.

Cardiac enzymes – Damage to heart muscle can raise the level of these enzymes. this is shown in a blood test.

Echocardiography – the use of ultrasound to investigate the heart.

Electrocardiographic changes – A graph of electrical activity of the heart showing variation from the normal which is

consistent with a heart attack.

Myocardial infarction – Heart attack.

Heart attack – out of hospital cardiac arrest

DescriPtion We will pay if an insured person suffers a cardiac arrest which:

•isn’tassociatedwithanymedicalprocedure,and

•isdocumentedbyanelectrocardiogram,and

•occursoutsideahospital,and

•isduetoeithercardiacasystoleorventricularfibrillation.

GlossArY oF terMs

Cardiac arrest – Sudden,andoftenunexpected,stoppageofeffectiveheartaction.

Cardiac asystole – complete failure of contraction of the heart causing cardiac arrest.

Electrocardiogram – A graph of electrical activity of the heart.

Ventricular fibrillation – Heart abnormality with ineffective twitching of the heart chambers.


Heart valve surgery

DESCRIPTION We will pay if an insured person has surgery to correct, or replace, a cardiac valve. in the

opinionofanappropriateconsultantmedicalspecialist,thetreatmentmustberequiredon

medicalgroundsandmustbethemostappropriatetreatment.

Wewon’tpayforsurgeryperformedusingintraluminalorlaparoscopicprocedures.

GlossArY oF terMs

Intraluminal techniques – Thetreatmentofinternalabnormalitiesbymeansofacatheterinsertedthrougha

superficialbloodvesseltoapplycertaintechniques,andnotinvolvinganopensurgical

operation.

HIV/AIDS–medicallyacquired

DESCRIPTION We will pay if the insured person acquires HiV through accidental infection as a result of a

medicalprocedure.Wewillonlypayifwebelieveonthebalanceofprobabilitiesthatthe

infectionarosebecauseofoneofthemedicaleventslistedbelow.

Theeventmusthavebeenmedicallynecessaryanditwasperformedbyorunderthe

supervision of a medical doctor or a dentist, and:

•itmusthaveoccurredtotheinsuredpersonineitherAustraliaorNewZealand,and

•itmusthaveoccurredasaresultofanyoneofthefollowingprocedures:

–abloodtransfusion

–thetransfusionwithbloodproducts

– an organ transplant to the insured person

– assisted reproductive techniques.

before we will pay, we will require proof of the incident via a statement from a statutory

Health Authority that the infection was medically acquired.

Wewon’tpayiftheHIVinfectionisacquiredthroughanyothercauseincludingbutnot

limited to sexual activity, intravenous drug use except as a legitimate medical procedure, or

deliberateself-infection.

GlossArY oF terMs

HIV – the Human immunodeficiency Virus. As the name implies over time infection with HiV

causestheimmunesystemtobecomedeficient,whichcanleadtothedevelopmentof

illnesses such as cancers.


HIV/AIDS–occupationallyacquired

DESCRIPTION WewillpayifaninsuredpersonbecomesinfectedwithHIVif:

•thevirusisacquiredasaresultofanaccidentoccurringduringthecourseoftheinsured

person’snormaloccupation,and

•thevirusisacquiredwhiletheinsuredpersonwascarryingouttheirnormaloccupational

duties, and

•seroconversiontotheHIVinfectionoccurswithin6monthsofthataccident.

Anyaccidentgivingrisetoapotentialclaimmustbereported:

•totherelevantauthorityoremployer,and

•touswithin14daysofitsoccurrence,and

•besupportedbyanegativeHIVantibodytesttakenaftertheaccident.

Wewillonlypayifweareableto:

•independentlytestallbloodsamplesused

•takefurthersamples

•obtainacopyofthereportmadetotherelevantinstitutionoremployer;and

•obtainallevidencerelatingtotheallegedsourceofinfection.

Wewon’tpayif:

•theHIVinfectionisacquiredthroughanyothercauseincludingbutnotlimitedtosexual

activity,recreationalintravenousdruguseordeliberateself-infection,or

•recommendedprecautionarymeasuresaren’ttakenbeforeorafterthepresumedcausal

event.

GlossArY oF terMs

HIV – the Human immunodeficiency Virus. As the name implies, over time infection with HiV

causestheimmunesystemtobecomedeficient,whichcanleadtothedevelopmentof

illnesses such as cancers.

Sero conversion – Thedocumentedchangefromtheabsencetothepresenceinthebloodofantibodies

totheHIV.Theseantibodiesusuallyappearinthebloodforthefirsttimewithin8to12

weeksofinfectionoccurringbutcanappearlater.


intensive care

DESCRIPTION We will pay if an insured person has an accident or illness which requires them to have

continuousmechanicalventilationbymeansoftrachealintubation.Thetrachealintubation

mustneedtocontinuefor10consecutivedays(24hoursperday)inanauthorised

intensivecareunitofanacutecarehospital.Wewon’tpaywheretheaccidentorillnessis

aresultofalcoholordrugusethatisn’tprescribedbyadoctor.

GlossArY oF terMs

Mechanical ventilation – Mechanically assisted movement of air into the lungs.

Tracheal intubation – Insertionofatubeintothetrachea.

Kidney failure

DESCRIPTION Wewillpayifaninsuredpersonsuffersirreversiblefailureofbothkidneyswhichrequires

either:

•continuingrenaldialysis,or

•transplantationofahumankidney.

in the opinion of an appropriate consultant medical specialist, the dialysis or transplant

mustberequiredonmedicalgroundsandmustbethemostappropriatetreatment.

Wewon’tpayintheeventoftemporaryrenaldialysisforacuteandreversiblekidney

failure.

GlossArY oF terMs

Kidney transplant – Transplantationofadonorkidneyintoanotherperson’sbody.

Renal dialysis – Theuseofdefinedfilteringtechniquestoremovewasteproductsnormallyexcretedbythe

kidney.

leukaemia

DESCRIPTION We will pay if an insured person is diagnosed with leukaemia.

GlossArY oF terMs

Leukaemia – Amalignantdiseaseofthebonemarrow,causingabnormalitiesintheblood,spleenand

lymph nodes.

liver failure

DESCRIPTION Wewillpayifaninsuredpersonsuffersirreversiblefailureoftheliverandasaresult

the only effective treatment option is to receive a liver transplant. in the opinion of an

appropriateconsultantmedicalspecialist,thetransplantmustberequiredonmedical

groundsandmustbethemostappropriatetreatment.

Wewon’tpayiftheliverfailureisdirectlycausedbyalcoholorrelatedtouseofother

drugsnotprescribedbyadoctor.


loss of hearing

DESCRIPTION Wewillpayifaninsuredpersonsuffersatotalandpermanentlossofhearing,both

naturalandassistedfrombothears.Acochlearimplantmustbedeemednecessarybyan

appropriateconsultantmedicalspecialist.Thismustbecertifiedatleast3monthsafterthe

abilitytohearwasfirstlost.


DESCRIPTION Wewillpayifaninsuredpersonsufferstotalandpermanentinabilitytoperformatleast2

of the activities of daily living without assistance from someone else.

Wewon’tpayforlossofindependentlivingcauseddirectlybyalcoholordrugabuse.

GlossArY oF terMs


loss of speech

DESCRIPTION Wewillpayifaninsuredpersontotallylosestheabilitytospeakduetoorganicbrain

diseaseoraccidentalinjury.Thelossmustbeirreversible.Wewon’tpayforlossofspeech

which is due to any psychological cause.

Lossofuseoflimbsand/orsight

DESCRIPTION Wewillpayiftheinsuredperson,becauseofphysicalseveranceorpermanentnerve

damage, totally and permanently loses the:

•useofbothfeet,or

•useofbothhands,or

•useofonefootandonehand,or

•sightinbotheyes(totheextentof6/60orless),or

•anycombinationof2of:ahand,afootorsightinaneye(totheextentof6/60orless).

lung failure

DESCRIPTION Wewillpayifaninsuredpersonsuffersirreversiblefailureofbothlungsrequiring

continuous oxygen supply and with FeV1 test results of consistently less than one litre.

GlossArY oF terMs

FEV1 – Forced expiratory volume in one second.


Major head trauma

DESCRIPTION We will pay if an insured person suffers an accidental head injury which produces

neurological deficit causing significant functional impairment which, in the opinion of an

appropriateconsultantmedicalspecialist,islikelytobepermanent.

GlossArY oF terMs


of function.

Functional impairment – Abnormalitiesofthenervoussystemproducingcertainsymptomsandresultinginsome

disorder of function.

Major organ transplant

DESCRIPTION We will pay if an insured person requires a transplant from a human donor of one of the

following whole organs and is placed on a waiting list at an Australian hospital:

•kidney

•heart

•liver

•lung

•pancreas.

Intheopinionofanappropriateconsultantmedicalspecialist,thetransplantmustbe

requiredonmedicalgroundsandmustbethemostappropriatetreatment.

Wewon’tpayintheeventofadonationbytheinsuredpersonofanorganfortransplant.


Melanoma

DESCRIPTION We will pay if the insured person has a malignant melanoma where the thickness is less

than1.5mmandtheClarklevelofinvasionisLevel2.Themelanomamustbeconfirmed

bypathologytestsandcharacterisedbytheuncontrolledspreadofmalignantcellsandthe

invasionofnormaltissue.Wewon’tpayforamelanomawherethethicknessislessthan

1.5mmandtheClarklevelofinvasionisLevel1.

We will pay:

•$10,000,or







GlossArY oF terMs

Clark Level – Aclassificationsystemdescribingthedepthofinvasionofamelanomapastthetoplayers

oftheskin.Theclassificationsarefrom1to5.

Melanoma – A malignant tumour of the skin, usually developing from a mole.

Motor neurone disease

DESCRIPTION We will pay if an insured person receives an unequivocal diagnosis of motor neurone

diseasebyanappropriateconsultantmedicalspecialist.

GlossArY oF terMs

Motor neurone disease – Disorderswithprogressivemuscleweaknessandwastingduetodestructionofnerves.

Multiple sclerosis

DESCRIPTION We will pay if an insured person receives an unequivocal diagnosis of advanced multiple

sclerosisbyanappropriateconsultantmedicalspecialist.Theremustbesignificant

neurologicaldeficitwhichcausespermanentinabilitytoperformanyoneoftheactivitiesof

daily living without assistance of someone else.

GlossArY oF terMs


Multiple sclerosis – Adiseasewithabnormalnervoustissueinthebrainandspinalcordwhichinterfereswith

the normal function of the nerves.


of function.


Muscular dystrophy

DESCRIPTION We will pay if the insured person receives an unequivocal diagnosis of muscular dystrophy

byanappropriateconsultantmedicalspecialist.

GlossArY oF terMs

Muscular dystrophy – An inherited disease which results in the muscles failing to function.

Myelodysplasia

DESCRIPTION Wewillpayiftheinsuredpersonisdiagnosedtohavemyelodysplasiabyanappropriate

consultant medical specialist. the condition must have progressed to the point that it is

permanentandtheseverityissuchthattheinsuredpersonrequiresabloodtransfusionat

leastmonthlyand/oradmissiontohospitalduetocomplicationsofthedisorderatleast4

times per year.

GlossArY oF terMs

Myelodysplasia – Abonemarrowdisorderleadingtosignificantimpairmentofnormalbloodformation

whichresultsinanaemia,reducedwhitebloodcellsandplatelets.

Myelofibrosis

DESCRIPTION Wewillpayiftheinsuredpersonisdiagnosedtohavemyelofibrosisbyanappropriate

consultant medical specialist. the condition must have progressed to the point that it is

permanentandtheseverityissuchthattheinsuredpersonrequiresabloodtransfusionat

least monthly.

GlossArY oF terMs

Myelofibrosis – Adisorderwhichcancausefibroustissuetoreplacethenormalbonemarrowandresultsin

anaemia,lowlevelsofwhitebloodcellsandplateletsandenlargementofthespleen.

open heart surgery

DESCRIPTION Wewillpayiftheinsuredpersonhasopenheartsurgeryrequiringdiversionoftheblood

through a heart-lung machine, in order to have surgery to correct any heart defect

including heart valve surgery. in the opinion of an appropriate consultant medical specialist,

thetreatmentmustberequiredonmedicalgroundsandmustbethemostappropriate

treatment.Wewon’tpayunderthisparticulartraumaconditionforproceduressuchas

valvotomyorcoronaryarteryangioplastywhichdon’trequireopenheartsurgery.

GlossArY oF terMs

Coronary artery angioplasty – Thetreatmentofaninternalabnormalitybytheinflationofaballooncatheterinserted

throughasuperficialbloodvesselandnotincludinganopensurgicaloperation.

Valvotomy – surgical widening of a narrowed heart valve.


Paralysis – diplegia

DESCRIPTION Wewillpayifaninsuredpersonsufferstotalandpermanentparalysisofbotharmsor

bothlegsduetoorganicdiseaseoraccidentalinjury.Wewon’tpayforpartialparalysis,for

temporary post-viral paralysis, or for paralysis due to psychological causes.

GlossArY oF terMs

Paralysis – Completelossoftheabilitytomovepartsofthebody.Itisasymptomofawidevarietyof

disorders.

Paralysis – hemiplegia

DESCRIPTION Wewillpayifaninsuredpersonsufferstotalandpermanentparalysisofboththearm

andthelegonthesamesideofthebodyduetoorganicdiseaseoraccidentalinjury.We

won’tpayforpartialparalysis,fortemporarypost-viralparalysis,orforparalysisdueto

psychological causes.

GlossArY oF terMs


disorders.

Paralysis – paraplegia

DESCRIPTION Wewillpayifaninsuredpersonsufferstotalandpermanentparalysisofbothlegsdueto

organicdiseaseoraccidentalinjury.Wewon’tpayforpartialparalysis,fortemporarypost-

viral paralysis, or for paralysis due to psychological causes.

GlossArY oF terMs


disorders.

Paralysis – quadriplegia

DESCRIPTION Wewillpayifaninsuredpersonsufferstotalandpermanentparalysisofbotharmsand

bothlegsduetoorganicdiseaseoraccidentalinjury.Wewon’tpayforpartialparalysis,for

temporary post-viral paralysis, or for paralysis due to psychological causes.

GlossArY oF terMs


disorders.


Paralysis – tetraplegia

DESCRIPTION Wewillpayifaninsuredpersonsufferstotalandpermanentparalysisofbotharmsand

bothlegs,togetherwithlossofheadmovement,duetoorganicdiseaseoraccidental

injury.Wewon’tpayforpartialparalysis,fortemporarypost-viralparalysis,orforparalysis

due to psychological causes.

GlossArY oF terMs


disorders.

Parkinson’sdisease

DESCRIPTION WewillpayifaninsuredpersonreceivesanunequivocaldiagnosisofadvancedParkinson’s

disease.Theremustbesignificantneurologicaldeficitwhichcausespermanentinabilityto

perform any one of the activities of daily living without assistance from someone else.

GlossArY oF terMs

Activities of daily living – Seerule40forthedefinition.


of function.

Parkinson’s disease – Aprogressivediseaseofthebrainwithmusclestiffnessandtremors.


Parkinson’sdisease(Partial)

DESCRIPTION WewillpayiftheinsuredpersonreceivesanunequivocaldiagnosisofParkinson’sdisease

asconfirmedbyanappropriateconsultantmedicalspecialist.

Parkinson’sDiseasemeanstheunequivocaldiagnosisofidiopathicParkinson’sDiseasedue

todegenerationinthenigrostriatalareaofthemidbrainandcharacterisedclinically,byone

or more of the following symptoms:

•rigidity

•tremor

•akinesia.

other forms of Parkinsonism, whether related to medication, toxins or other

neurodegenerative conditions are specifically excluded.

We will pay:

•$10,000,or







Akinesia – Absence,loss,orimpairmentofthepowerofvoluntarymovement.

Nigrostriatal system – Anareadeepwithinthebrain.

Parkinson’s disease – Aprogressivediseaseofthebrainwithmusclestiffnessandtremors.


Partialblindness

DESCRIPTION We will pay if the insured person:

•losesthesightinbotheyeswithirreversibleeyedamagetotheextentof6/24,or

•losesthesightinoneeyewherevisualacuityhasreducedto6/60orlessinthatoneeye,

andthelossisunabletobecorrectedbyglassesoranyothermeans.

We will pay:

•$10,000,or







Peripheralbloodstemcellorbonemarrowtransplant

DESCRIPTION Wewillpayifaninsuredpersonreceivesabonemarrowtransplant,orperipheralblood

stem cell transplant for the treatment of lymphoma or leukaemia. in the opinion of an

appropriateconsultantmedicalspecialist,thetransplantmustberequiredonmedical

groundsandmustbethemostappropriatetreatment.

Wewon’tpayintheeventofadonationbytheinsuredpersonofanorganfortransplant.


Peripheral neuropathy

DESCRIPTION Wewillpayifaninsuredpersonisdiagnosedtohaveperipheralneuropathybyan

appropriate consultant medical specialist. the condition must have progressed to the point

thatitispermanentandresultsintheinsuredpersonnotbeingabletodoanyoneormore

ofthebelowactivitieswithoutassistancefromsomeoneelse:

•getinandoutofabed

•getonoroffachair/toilet

•movefromplacetoplacewithoutusingawheelchair.

Wewon’tpayiftheperipheralneuropathyisdirectlycausedbyalcoholorrelatedtouseof

otherdrugsnotprescribedbyadoctor.

Wewon’tpayifthisconditioniscontributedtoorcausedbyHIV/AIDSrelatedconditions.

GlossArY oF terMs

Peripheral neuropathy – Adiseaseofthenerveswhichaffectspeople’sabilitytousetheirarms,orhandsorlegsor

feet.

Pneumonectomy

DESCRIPTION We will pay if the insured person undergoes surgical removal of an entire lung. in the

opinion of an appropriate consultant medical specialist, the insured person must require

thetreatmentonmedicalgroundsanditmustbethemostappropriatetreatment.


Primary pulmonary hypertension

DESCRIPTION We will pay if an insured person suffers primary pulmonary hypertension associated with

therightventriclebeingenlargedandthis:

•isestablishedbycardiaccatheterisationand/orechocardiography,and

•resultsinpermanentphysicalimpairmenttoatleastClass3(markedlimitationofactivity

bysymptoms)oftheNewYorkHeartAssociationClassificationofCardiacImpairment.

Wedon’tpayforanyothercausesofpulmonaryhypertension.

GlossArY oF terMs

Cardiac catheterisation – Atubeinsertedintotheheartorcoronaryarteries.

Echocardiography – the use of ultrasound to investigate the heart.

New York Heart Association

Classification of Cardiac Impairment – Isafunctionalclassificationtoassesscardiovasculardisability.

Class 3 – Physicalimpairmentconstitutedbyamarkedlimitationofphysicalactivity.Theinsured

personwillbecomfortableatrest,butlesswhileengaginginordinaryactivity.

Primary pulmonary hypertension – A condition, cause unknown, associated with increased pressure in the heart-lung

circulation,andmanifestedbyanenlargedrightventricleoftheheart,asconfirmedby

chest x-ray, ecG, echocardiogram and cardiac catheter studies.

Right ventricle – Oneofthemajorlowerchambersoftheheart.

9%

18%

18%

18%

9%9%

1%


Prostate cancer

DESCRIPTION We will pay if an insured person is diagnosed as having a prostate tumour equivalent to

TNMClassificationT1andaGleasonscoreoflessthan8.Thetumourmustbeconfirmed

bypathologytestsandcharacterisedbytheuncontrolledspreadofmalignantcellsandthe

invasion of normal tissue.

We will pay:

•$10,000,or







GlossArY oF terMs

Gleason score – A grading method assigned to indicate how aggressive the tumour is.



Severeburns

DESCRIPTION Wewillpayifaninsuredpersonsuffersthirddegreeburnsto20%ormoreoftheirbody

surfaceareaasmeasuredbytheLundBrowderBodySurfaceChartshownonthispage.

Theburnscanbecausedbythermal,electricalorchemicalagents.

Thehead(includingtheneck)andeacharm(includingthehand)areseparatelyconsidered

tobe9%ofthetotalbodysurface.Thefront,backandlegs(includingfeet)areeach

separatelyconsideredtobe18%ofthetotalbodysurface,withtheremaining1%being

the perineal area.

Wewillalsopayiftheinsuredpersonsuffersthirddegreeburnstothewholeofboth

hands or the whole of the face where grafting is required.

lund browder body surface chart


Severeinflammatoryboweldisease

DESCRIPTION WewillpayifaninsuredpersonsuffersSevereinflammatoryboweldisease.Severe

inflammatoryboweldiseasemeansadiagnosisofCrohn’sdiseaseand/orulcerativecolitis

that has failed surgical and conventional medical intervention and requires indefinate

second-line therapy.

We will pay:

•$10,000,or







GlossArY oF terMs

Crohn’s disease – A chronic inflammatory disease, primarily involving the small and large intestine, which can

affect other parts of the digestive system.

Immunosuppressive – Capableofsuppressingtheimmuneresponse.

Ulcerative colitis – Aninflammatoryboweldiseasethatcausesinflammationandsores(ulcers)intheliningof

the large intestine.


severe osteoporosis

DESCRIPTION We will pay if an insured person suffers severe osteoporosis. severe osteoporosis means

theinsuredperson,beforetheageof50,suffersatleasttwovertebralbodyfracturesora

fractureoftheneckorfemur,duetoosteoporosisandhasbonemineraldensityreading

withaT-scoreoflessthan-2.5.Thismustbemeasuredinatleasttwositesbydualenergy

x-rayabsorptiometry(DEXA).

We will pay:

•$10,000,or







GlossArY oF terMs

Osteoporosis – Asofteningofthebonesthatgraduallyincreasesandmakesthemmorefragile.

T-score of less than -2.5 – 2.5standarddeviationsbelowtheyoungadultmeanforbonedensity.

Dual energy X-ray absorptiometry (DEXA) – Animagingtestthatmeasuresbonedensitybypassingx-rayswithtwodifferentenergy

levelsthroughthebone.

severe rheumatoid arthritis

DESCRIPTION Wewillpayifaninsuredpersonisdiagnosedashavingsevererheumatoidarthritis,byan

appropriate consultant medical specialist who recommends reconstructive surgery as part of

the most appropriate treatment, where response to conventional disease modifying therapy

hasfailedandtheconditionhasprogressedtothepointthattheinsuredpersoncan’t

perform any one of the activities of daily living without assistance from someone else.

Wewon’tpayforanyotherformofarthritis.

GlossArY oF terMs

Activities of daily living – Seerule40forthedefinition.

Severe rheumatoid arthritis – chronic active arthritis with no complete freedom from pain and moderate or marked

deformities with serious restrictions of movement and impairment of function.


stroke

DESCRIPTION Wewillpayifaninsuredpersonsuffersacerebrovascularepisodeproducingneurological

damagewhichlastsformorethan24hours.

Thedamagemustbeevidencedclinicallyby:

•cerebralCTscan,or

•anangiogram,or

•anMRIorPET,or

•otherreliableimagingtechniquesapprovedbyAMPLife.

Wewon’tpayfortransientischaemicattacks,reversibleischaemicneurologicaldeficit,

major head injuries or symptoms due to migraine or headache.

GlossArY oF terMs

Cerebrovascular episode – Aneventwherethebloodsupplytopartofthebrainisimpaired.

CT scan, angiogram, MRI or PET – Varietyoftestswhichprovideimagesofanorgansuchasthebrain.Thesetestsareusedto

defineabnormalitiessuchastumourordamagetoanorganfromimpairedbloodsupplyor

injury.

Neurological damage – Damagetothebrain,spinalcordornerveswherethenormalstructureandfunctionhas

beenaffectedresultinginsymptomssuchasimpairedvision,speechorparalysis.

Transient ischaemic attack – Aneventwherethereistemporaryinterruptionofthenormalbloodflowtothebrain,

resultingintemporaryabnormalitiesofbrainfunctionandleadingtosymptomssuchas

impairmentofbalance,vision,speechorco-ordinationwhicharen’tpermanent.Recovery

ofnormalfunctionoccurswithin24hours.

Reversible ischaemic neurological deficit – Abnormalityofneurologicalfunctionwhichlastsfor24hoursbutwhichisreversible.

Subacutesclerosingpanencephalitis

DESCRIPTION Wewillpayifaninsuredpersonsufferssubacutesclerosingpanencephalitis.

GlossArY oF terMs

Subacute sclerosing panencephalitis – Aprogressiveandfataldiseaseofthebrainsuspectedtobeofviralorigin.


systemic lupus erythematosus

DESCRIPTION WewillpayifaninsuredpersonsuffersSystemiclupuserythematosus(SLE)where

irreversibleorgandamagehasoccurredrequiringintravenousimmunosuppressiveor

cytotoxictherapy.Theorgandamageincludeslupusnephritis,cerebrallupus,cardiac

disease specially related to sle. An appropriate consultant medical specialist must confirm

the diagnosis of sle with pathological and other supporting evidence.

GlossArY oF terMs

Cerebral lupus – Achronicautoimmunediseasecharacterisedbyinflammationinthebrain.

Cytotoxic therapy – A process that kills cells.

Immunosuppressive – Capableofsuppressingtheimmuneresponse.

Lupus nephritis – A kidney disease that occurs with sle and often leads to renal failure.

Systemic lupus erythematosus – Achronicinflammatoryconditionaffectingtheinternalorgans,causedbyanautoimmune

disease.

systemic sclerosis

DESCRIPTION Wewillpayifaninsuredpersonisdiagnosedtohavesystemicsclerosisbyanappropriate

consultant medical specialist. the condition must have progressed to the point that the

insuredpersoncan’tperformanyoneoftheactivitiesofdailylivingwithoutassistance

from someone else.

GlossArY

Activitiesofdailyliving– Seerule40forthedefinition.

Systemicsclerosis– Aprogressiveskindisorderwhichischaracterisedbythickeningandtighteningoftheskin

affecting the face and hands. the disease also affects internal organs.

Viral encephalitis

DESCRIPTION Wewillpayifaninsuredpersonsuffersencephalitisduetodirectviralinvasionofthe

central nervous system. the encephalitis must produce neurological deficit causing

permanent and significant functional impairment.

GlossArY oF terMs

Encephalitis– Inflammationofthebrain.

Neurologicaldeficit– Abnormalitiesofthenervoussystemproducingcertainsymptomsandresultingindisorders

of function.


Glossary of definitions

40.

GLOSSARYOFDEFINITIONS

ACTIVITIESOFDAILYLIVING 1. Washing: the insured personcanwashthemselvesbysomemeans.

2.Dressing:the insured person can put clothing on or take clothing off.

3. Feeding: the insured person can get food from a plate into their mouth.

4.Continence:the insured personcancontrolboththeirbowelandtheirbladder

function.

5.Mobility:the insured person can:

a)getinandoutofabed

b)getonoroffachair/toiletand

c)movefromplacetoplacewithoutusingawheelchair.

buY bAcK see rule 11.2

cArer Theprimarycaregiver,whoprovidesassistancewithcommunication,mobilityorself-careto

adisabledoragedperson,formorethan6months.

certiFicAte oF insurAnce Certificate of Insurance is the certificate we send you when the plan starts.

the certificate sets out the details of who owns the plan, who is insured, the amount of

cover,andotherimportantinformationabouttheplan when it starts.

the certificate and the Plan rules in this document form your contract with AMP.

the information in the Certificate of Insurance canbeupdatedinthefollowingtwoways:

•first,intheAnnualStatementwesendyoueachyear,and

•second,ifyouaskustochangetheplan and we agree to it, we will send you a

MemorandumofAlteration recording the change.

We suggest that you keep each Annual statement and each Memorandumof

Alteration with the Certificate of Insurance.


cPi CPI means consumer Price index.

When we make a calculation using the increase in the CPI, we use the percentage increase

intheAustralianNationalAllGroupsConsumerPriceIndexpublishedbytheAustralian

BureauofStatistics.However,ifthatindexisabolishedorchanged,wemayuseanother

indexwhichwebelievefairlyandaccuratelyreflectschangesinthecostofliving.

When calculating the increase to the plan fee or the amount of cover, we use the annual

percentageincreasetotheindexfortheSeptemberquarterinthepreviouscalendaryear.

DOCTOR Doctor means a legally qualified medical practitioner registered to practise in Australia,

NewZealand,theUnitedKingdom,theUnitedStatesofAmerica,orCanada.

Thatpersonmaynotbe:

•you,yourbusinesspartner,oramemberofyourimmediatefamily,or

•theinsured person, the insured person’sbusinesspartner,oramemberofthe

insured person’s immediate family.

HOMEDUTIES An insured person is engaged in home dutiesiftheyaredoingatleast4ofthe

following duties related to running the family home:

•cleaningthefamilyhome

•shoppingforfoodandhouseholditems

•mealpreparation

•laundryservices

•caringforachildordependant(ifapplicable).

INSUREDPERSON

LINKED

linked cover means that each type of cover for an insured person is dependent on each

other type. if we pay under one type of cover, the amount of each remaining type of cover

that applies to an insured personisreducedbytheamountwepay.

MEMORANDUMOFALTERATION MemorandumofAlteration is a document we send you confirming a change to the plan.

MontH Month means calendar month.

oWn occuPAtion Your Own Occupation is the primary full-time occupation you have performed

immediatelypriortobecomingdisabled.ThisoptionisonlyavailabletoclassAoccupations

which include professional and white collar workers.

PlAn Plan means the rules in this document, the Certificate of Insurance, your Annual

statements and any documents we send you recording a change to your plan.

Insured person is explained under the heading ”Insured person” on page 1.


PlAn AnniVersArY the date of the plan anniversary for the plan appears in the Certificate of Insurance.

For most plans,itwillbethesamedateineachyearasthedateonwhichtheplan starts.

However,ifyouwantittobeadifferentdate,wemayagreetomakeitadifferentdate.

the plan anniversary is the date in each year on which we make any CPI increase to the

types of cover. When we recalculate the premium each year, the new amount applies for

one year from the plan anniversary.

PlAn oWner Plan owner is the person who owns the plan and whom we pay. We call that person

“you”. More than one person may own the plan. if it is a superannuation plan, it is owned

byAMPSuperannuationLimited.

PreMiuM the premiumistheamountpayableforyourplan, calculated from our premium rates.

it includes the plan fee, premium frequency fee, any discounts or loadings and any

government fees, duties or charges.

PreMiuM rAtes Premium ratesmeansthestandardrateswesetandusetocalculatethebasepremium.

Theydependonanumberoffactorsincluding:eachinsured person’s age, sex, health,

pastimes,smokinghabitsandoccupation.

reGulAr reMunerAtiVe WorK An insured person is engaged inregularremunerativework if they are doing work

inanyemployment,business,oroccupationforatleast10hoursperweek.Theymustbe

doing it for reward, or the hope of reward of any type.

REINSTATEDTRAUMACOVER see rule 11.3.

sPeciAl rule Special rule means any rule which we apply to a particular insured person and which

doesn’tnecessarilyapplytoallotherFlexibleLifetime–Protectionplans.

STANDALONE Stand alone cover means that each type of cover is completely independent of all other

types of cover that apply to an insured person under this plan. if we pay under one type

of cover, it does not affect the amount of any other cover for that insured person. the

onlytimethisdoesn’tapplyisifwepayunderTerminalIllnessbenefit,whenwereducethe

amountoftheDeathcoverthatappliestotheinsured personbytheamountwepay.

TERMINALLYILLANDTERMINALILLNESS An insured person is terminally ill if they are diagnosed as having less than 12 months

to live. Terminal illness has a corresponding meaning.


TOTALLYAND An insured personcanbetotally and permanently disabled if they:

PERMANENTLYDISABLED

•areunabletowork,or

•areunabletoperformspecifiedhome duties, or

•sufferlossofuseoflimbsand/orsight,or

•sufferlossoftheabilitytoperformtheactivities of daily living, or

•sufferlossofcognitivefunction,

andmeetthedefinitionsofanyoftheaboveasdescribedintheTPDtableonpage68.

TOTALLYDISABLED An insured person is totally disabledwhiletheyareunabletoengageinanyregular

remunerativeworkforwhichtheyarereasonablyfittedbytheireducation,trainingor

experience.Theymustbeunabletodothatbecausetheyhavesufferedanillnessorinjury.

TRAUMACONDITION the trauma conditions covered under trauma cover standard, trauma cover Premier and

the Partials Plus option are listed in rule 3.

the trauma conditions coveredunderChildren’sTraumacoverarelistedinRule7.1.

the full description of each trauma condition is set out in rule 39.

You, Your You and your and yourself in relation to superannuation plans means the insured

person; and means the plan ownerinrelationtoDeath,TotalandPermanent

Disablement,Traumaplans.


Definition of Totally and Permanently Disabled

Definition The insured person is totally and permanently disabled if they:

Part 1

Unabletowork

•sufferanillnessorinjury,and

•theillnessorinjurywhollypreventsthemfromengaginginregularremunerativework for at least 6months in a row, and

•sincetheybecameillorinjured,theyhavebeenundertheongoingcareandattentionofadoctor for that illness or injury, and

•inouropinion,theillnessorinjurymeansthattheyareunlikelytoeverworkinregular remunerative workforwhichtheyarereasonablyfittedbyeducation,trainingorexperience.

the insured personmustalsosurvive6months.

Uponadmittanceofyourclaim,wewillrefundanypremiumsfallingdueduringthis6month period, thathavebeenpaidfortheinsured person.

Part 2

Unabletowork–Own occupation(Part2isonlyapplicableto insured persons who have selected the own occupationoption)


•theillnessorinjurywhollypreventsthemfromengagingintheirown occupation for at least 6months in a row, and


•inouropinion,theillnessorinjurymeansthattheyareunlikelytoeverworkintheirown occupation.


Uponadmittanceofyourclaim,wewillrefundanypremiumsfallingdueduringthis6month period, thathavebeenpaidforthe insured person.

Part 3

Home duties


•theillnessorinjurywhollypreventsthemfromengagingin home dutiesforatleast6months in a row, and


•inouropinion,theillnessorinjurymeansthattheyareunlikelytoeverattendtohome duties.


Uponadmittanceofyourclaim,wewillrefundanypremiumsfallingdueduringthis6month period, thathavebeenpaidfortheinsured person.

Part4

Lossofuseoflimbsand/orsight

•sufferfromthetotalandirrecoverablelossof:

–theuseoftwolimbs,or

–thesightofbotheyes,or

–theuseofonelimbandthesightofoneeye

wherealimbmeansthewholehandbelowthewristorthewholefootbelowtheankle.

Thelossmustbeunabletoberemediedandtheinsured personmustsurvivefor14daysaftertheloss.

Part5


•becometotallyandpermanentlyunabletoperformatleast2oftheactivities of daily living without assistance from someone else.

Wewillnotpayforlossofindependentlivingcauseddirectlybyalcoholordrugabuse.

the insured personmustsurvivefor14daysaftertheloss.

Part6

loss of cognitive functioning

•suffersignificantandpermanentcognitiveimpairmentwithalossofintellectualcapacity,and

•theyarerequiredtobeunderthecontinuouscareandsupervisionofsomeoneelse.

the insured personmustsurvivefor14daysaftertheloss.


enquiries and complaints

contAct us Ifyouneedanyadditionalinformationaboutyourplan, or if you have a concern or

complaint, then please contact your financial planner or contact AMP customer service on

131267.

if you want to write to us, our address is:

AMP life limited

POBox300

PARRAMATTANSW2124

OurCustomerServiceOfficersareavailabletoansweryourenquiriesandcomplaints.

Wewilltrytoresolveyourenquiryorcomplaintasquicklyaspossible.Tohelpusdothis,

pleasegiveusasmuchinformationaboutyourcomplaintaspossible.

Wehaveestablishedprocedurestodealwithanycomplaints.Ifyoumakeacomplaint,we

will:

•acknowledgeitsreceiptandensureanappropriatepersonproperlyconsidersthe

complaint; and

•respondtoyouassoonaswecan.

Ifyourcomplaintcannotberesolvedatfirstcontact,thenwewillkeepyouinformedofthe

progressandaimtogiveyouaresponsetoyourcomplaintwithin10workingdays.Ifthe

complaintisnotresolvedbythattime,thenwewillkeepyouadvisedatregularintervalsof

the status of your complaint.

Ifwecannotresolveyourcomplainttoyoursatisfactionwithin45days,thenyoumayhave

therighttolodgeacomplaintwiththeFinancialIndustryComplaintsService(FICS)(contact

detailslistedbelow).

Thisindustrysponsoredexternalservicewasestablishedtohelpclientswithcomplaints

they cannot resolve directly with their company. it is independent and impartial. Please try

toresolveyourcomplaintdirectlywithusbeforecontactingtheFICS.

Financial industry complaints service

Telephone:(03)86232000or1300780808

Fax:(03)96212291

email: [email protected]

or write to

POBox579,CollinsStreetWest

MelbourneVIC8007

Additionally,forFlexibleLifetime–Protection(Superannuation)members,ifwecannot

resolveyourcomplainttoyoursatisfactionwithin90days,thenyoumayhavetherightto

lodgeacomplaintwiththeSuperannuationComplaintsTribunal(SCT)(contactdetailslisted

below).


the sct reviews the decisions of superannuation trustees as they affect an individual

member.Itisindependentfromus.Evenso,pleasetrytoresolveyourcomplaintdirectly

withusbeforecontactingtheSCT.

SuperannuationComplaintsTribunal

Telephone:1300780808

or write to

LockedBag3060,

GPOMelbourneVIC3001

tiMe liMits on MAKinG if you contact the sct more than 12 months after our decision or response, then the sct

coMPlAints to tHe sct may decide not to deal with your complaint. However, this general rule does not apply to a

complaintaboutthedenialofatotalandpermanentdisablement(TPD)claim(seebelow).

Ifwedenyyourtotalandpermanentdisablement(TPD)claim,thenyoumaybeunableto

make a complaint to the sct:

•ifyoulodgeaTPDclaimwithusmorethan2yearsafteryoupermanentlystopworking,

or

•ifyoucomplaintotheSCTmorethan2yearsafterourfirst(original)decisiontodeny

yourTPDclaim.

You should contact the sct first to ensure that it can deal with your complaint.


Thispagehasbeenleftblankintentionally.

Directory

AMP Life LimitedREGISTERED OFFICE

Level24

AMP Building

33 Alfred Street

SYDNEYNSW2000

Phone:0292575000

Fax:0292577886

AMP Customer Service CentrePHONE

131267

Monday to Friday

FAx

1300301267

ADDRESS

AMP Financial Services

Jessie Street Building

POBox300

PARRAMATTANSW2124

WEBSITE

www.amp.com.au

EMAIL

[email protected]

AMPLifeLimitedABN84079300379 33AlfredStreetSydneyNSW2000

90438311/07

advice

investments

banking

retirement income

superannuation

insurance

Contact your adviser or financial planner

telephone131267 web www.amp.com.au email [email protected]

If you have any enquiries or complaints please mention your plan number

plan rules - riskinforiskinfo.com.au/.../files/2008/08/amp-death-tpd-plan-rules.pdf · amp flexible...

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